髋臼骨折手术治疗的临床观察

A Follow-up Study of Surgical Treament of Acetabular Fractures

目的探讨髋臼骨折的手术治疗方法及疗效。方法对63例髋臼骨折按不同类型选择入路手术治疗。术后随访6～72个月,平均42.6个月。骨折复位情况按Matta复位标准,髋关节功能评价按Merle d’Aubigne标准。异位骨化评价按Brooker分级法。结果骨折解剖复位53例,满意复位5例,不满意复位5例;末次随访时髋关节功能:优56例(88.8%),良3例(4.8%),可2例(3.2%),差2例(3.2%)。异位骨化:Ⅰ级6例,Ⅱ级3例,Ⅲ级3例,Ⅳ级0例。创伤性关节炎2例,股骨头缺血坏死1例。结论正确判断骨折类型,选择最佳手术时机和入路、准确复位、坚强内固定是提高髋臼骨折手术疗效的关键。

Objective To summarize the techniques and results in surgical treament of acetabular fractures. Methods All 63 patients affected by acetabular fractures were treated surgically by different approach according type of acetabular fractures, all the cases followed-up from 6 to 72 months with an average of 42.6 months. Postoperative reduction quality were evaluate according to Matta criteria, and functional outcome by Merle d＇ Aubigne criteria. The heterotopic ossification evaluated according to Brooker classification. Results Anatomic reduction were obtained in 53 cases, satisfactory reduction in 5, unsatisfactory in 5 ; The clinical outcome at the time of final follow-up was as graded as excellent in 56 cases （ 88.8% ）, good in 3 （4.8%）, fair in 2 （ 3.2% ）and poor in 2 （ 3.2% ）. According to Brooker classification, there were 6 in grade I , 3 in grade II , 3 in grade III ,0 in grade IV . And 2 osteoarthritis and 1 avascular necrosis of femoral head were found. Conclusion To estimate the fracture type accurately before operation, select proper timing and approach, exact reduction and stable fixation are the most important way to improve the curative effects of acetabular fractures.