复杂性髋臼骨折治疗的临床研究

Clinical research on treatment of complex acetabular fractures

目的研究复杂性髋臼骨折的治疗方式并观察治疗效果。方法回顾性的选取我院骨科2010～2011年间治疗的50例复杂性髋臼骨折的患者为观察对象,按照Letournel-judet[1]的分型,其中横行伴后壁骨折5例,前柱并后方伴横行骨折8例,双柱骨折6例,T形骨折13例,后柱伴后壁骨折8例。对于不同的骨折给予不同的手术入路途径进行手术复位治疗。结果所有患者治疗后痊愈出院,术后全部患者均获随访,在随访中发现所有患者术后均无切口感染、深静脉栓塞、坐骨神经及股神经损伤等并发症的产生。手术复位后依据Matta[2]的X线片复位标准:解剖复位37例,复位满意20例,复位不满意3例,所有骨折经治疗均愈合。术后临床治疗效果依据D'Aubigne and Postel[3]评分标准来进行评价,60例患者中优47例,良7例,可3例,差3例,优良率90.00%,术后未发生任何并发症。结论对于复杂性髋臼骨折的治疗一般选择手术切开复位重建板内固定,对于不同的患者选择不同的治疗方式,准确把握手术的时机,合理的处理合并损伤,积极的预防和治疗并发症都是提高手术成功和远期预后的关键因素。

Objective To study the complexity of the treatment of acetabular fractures and to observe the therapeutic effect.Methods A retrospective selection of orthopedic hospital between 2010-2011,50 cases of complex treatment of acetabular fracture patients to observe the object,according to Letournel-judet sub-type,in which transverse with posterior wall fracture in 5 cases,the former column and rear with transverse fractures in 8 cases,double-column fracture in 6 cases,T-shaped fracture in 13 cases,posterior column with posterior wall fractures in 8 cases.Fracture for different surgical approaches offer different ways for surgical reduction treatment.Results All patients were discharged after treatment,all patients were followed up after surgery,all patients in the follow-up found no postoperative wound infection,deep vein thrombosis,sciatic and femoral nerve damage and other complications.Matta after surgical reduction of the X-ray film according to reset criteria： anatomic reduction in 37 cases,satisfactory reduction in 20 cases,reset unsatisfactory in 3 cases,all fractures healed after treatment.Postoperative clinical outcomes based on D＇Aubigne and Postel scoring criteria to be evaluated,60 patients were excellent in 47 cases,good in 7 cases,3 cases and poor in 3 cases,good rate of 90.00%,without any postoperative complications.Conclusions For complex acetabular fractures,we usually choose surgical reconstruction plate fixation with open reduction,selection of patients for different treatment in different ways,to accurately grasp the timing of surgery,treatment of combined injury rational,positive prevention and treatment of complications are the key factors to improve the surgical success and long-term prognosis.