移位髋臼骨折的内固定疗效及影响因素分析

Analysis of clinical outcome of open reduction and internal fixation for displaced acetabular fracture

目的观察切开复位内固定治疗移位髋臼骨折的远期疗效，分析影响远期疗效的危险因素。方法回顾性分析2005年8月至2009年2月诊治并获随访的62例移位髋臼骨折患者的临床资料，全部病例采用切开复位钢板螺钉内固定，对其远期疗效及可能影响疗效的危险因素进行分析。结果术后随访24～52（38．8±2．6）个月。按照Matta复位标准，解剖复位43例，满意复位14例，较差复位5例；骨折均愈合。根据改良的Meded’Aubigne．Postel评分系统评定：优良50例，可差12例，优良率为80．65％（50／62）。主要并发症为创伤后骨关节炎7例、异位骨化3例、股骨头缺血性坏死1例。远期疗效与年龄、Letournel-Judet骨折分型、手术时机、股骨头软骨面是否损伤和复位质量5个因素相关（P〈0．05）；而与性别、AO分型、手术入路、有无髋关节脱位无关（P〉O．05）。结论切开复位钢板螺钉内固定能使移位髋臼骨折恢复正常解剖形态，有利于关节功能的恢复，远期疗效较好；年龄、Letoumel-Judet骨折分型、手术时机、股骨头软骨面是否损伤和复位质量是影响远期疗效的主要因素。

Objective To explore the long-term effect of open reduction and internal fixation for the treatment of displaced acetabular fracture, and analyze the influence of risk factors. Methods The clinical data of 62 patients with acetabular fracture from August 2005 to February 2009 was analyzed retrospectively. All the cases were treated with open reduction and internal fixation. The long-term effect and related risk factors were analyzed. Results All the cases were followed up for 24-52（38.8 ＋ 2.6） months. According to the Matta standard of replacement of fracture, there were 43 cases with anatomic reduction, 14 cases with satisfactory reduction, 5 cases with unsatisfactory reduction. Fracture union was obtained in all the patients. Based on the modified Merled＇ Aubigne -Postel clinical grading system, the result was excellent and good in 50 patients, fair and poor in 12 patients, with excellent rate of 80.65% （50/62）. Postoperative complications including traumatic arthritis were seen in 7 patients, heterotopic ossification in 3 patients and femoral head avascular necrosis in 1 patient. The related risk factors of clinical results of displaced acetabular fracture were age, Letoumel-Judet fracture type, operation time, cartilage surface damage of the femoral head and quality of reduction （P〈 0.05）. However, gender, AO fracture type, surgical approach and hip dislocation were not affecting factors of the acetabular fracture（P 〉 0.05）. Conclusions Open reduction and internal fixation can result in a satisfactory clinical outcome. Age, Letournel-Judet fracture type, operation time, cartilage surface damage of the femoral head and quality of reduction are independent risk factors affecting postoperative long-term functional outcomes.