骨盆合并髋臼骨折的临床特征分析

Clinical characteristics of pelvic fracture associated with acetabular fracture

目的研究骨盆合并髋臼骨折的临床特征。方法对2007年5月～2009年5月收治的558例患者中的50例骨盆合并髋臼骨折患者的临床资料进行分析,包括性别、年龄、致伤原因、骨折类型、合并损伤、ISS评分、手术时间、术后并发症以及预后等情况。结果骨盆合并髋臼骨折发生率为8.5%,平均年龄(33.9±13.3)岁。最常见的致伤原因为车祸伤,最常见的骨盆骨折类型是AO/OTA61A2和61B1型,最常见的髋臼骨折类型是AO/OTA62A1和62B1型。双侧耻骨支骨折是最常见的前环损伤,同侧骶髂关节骨折脱位是后环损伤最常见的形式。此外,头、胸、腹部以及四肢损伤是常见的合并伤。25例患者接受了手术治疗,从受伤到接受手术时间为平均6.0d(0～15d),平均住院时间为16d(10～22d)。平均随访时间为14个月(12～14个月),骨折均愈合。术后髋臼复位Matta分级中解剖复位9例(36.0%),良好11例(44.0%),可5例(20.0%);差(0)。术后Majeed评分优良22例,占88.0%。结论骨盆骨折合并髋臼骨折是一种严重的高能损伤类型,在急诊抢救复苏、诊治以及二期手术精确复位方面均存在很多困难。为获得良好的髋臼复位,骨盆后环损伤的早期精确复位是必要的。

Objective To investigate the clinical characteristics in the combination of pelvic and acetabular fractures. Methods 50 cases of pelvic fracture associated with acetabular fracture were chosen from 588 cases of pelvic and/or acetabular fractures from May 2007 to May 2009. The demography of the cases included gender, age, cause, classification, associated injury, ISS score, operation time, complication and outcome. Results The occurrence of the combined injuries was 8.5%, and the mean age was （33.9 ± 13.3） years old. Traffic accident was the most popular cause. 61A2 and 61B1 were the most common types according to the AO/OTA classification. Pubic rami fracture on both sides were the most common type in the anterior ring of pelvis while the sacroiliac joint fracture-dislocation was the most common in the posterior. Brain injury, thoracic injury and abdominal injury were the most common associated injuries. 25 cases were surgically treated; the mean time from the injury to the operation was six days （ranging from 0 to I5 days） and the median length of hospital stay was 16 days （rang from 10 to 22 days）. The mean follow-up time was 14 months （range from 12 to 24 months）. All the pelvic and acetabular fractures united. Matta scoring system was applied to evaluate the reduction of the acetabulumn and the result was excellence in nine cases （36.0%）, good in 11 （44. 0% ）, and general in five （20. 0% ）. The functional outcome was good to excellence in 22 cases （88. 0% ） according to the Majeed scoring system. Conclusions The combination of pelvic and acetabular fracture is a kind of heavily injury type and the emergency resuscitation, diagnosis, treatment and precise reduction remain challenges for orthopaedic surgeons. Precise reduction of the posterior ring of the pelvis is necessary for the good reduction of the acetabular fractures.