髋臼骨折的手术治疗

The operation treatment of acetabulum fracture

目的探讨髋臼骨折的分型、手术入路的选择及手术效果。方法手术治疗22例髋臼骨折患者,后壁骨折和后柱加后壁骨折选择K-L入路,前柱、前壁骨折及横断骨折选择髂腹股沟入路,前后移位明显的横断骨折、T形骨折、双柱骨折选择前后联合入路。结果 22例均获随访,时间6个月～5年,骨折6～9个月均愈合。按Matta评定标准:解剖复位9例,满意复位13例。根据改良的Merle d'Aubigne-Poster髋关节功能评分标准:优7例,良10例,可4例,差1例。1例股骨头坏死,3例创伤性关节炎,2例异位骨化。结论按髋臼骨折的分型选择合适的手术入路和良好的骨折复位内固定是获得满意疗效的前提。

Objective To investigate the classification of acetabular fracture, operation approach and operation effect. Methods The operation treatment was done for 22 cases of patients with acetabular fracture. Posterior wall fracture and posterior column fracture with posterior wall were operated through K-L approach, anterior column, anterior wall fractures and horizontal fractures were operated through ilioinguinal approach. Anterior and posterior displaced trans- verse fracture, fracture of type T, double column fractures were operated through combined anterior and posterior approach. Results 22 cases were followed up for 6 months to 5 years. All fractures got healing in 6 - 9 months. According to Matta standards, anatomical reduction was obtained in 9 cases, and satisfactory reduction in 13 cases. Ac- cording to the modified Merled Aubigne-Poster hip score criteria, the results were excellent in 7 cases, good in 10, fair in 4, and poor in 1. 1 patient was complicated with femoral head necrosis, 3 with traumatic arthritis, and 2 with heterotopic ossification. Conclusions The acetabular fracture type, appropriate operation approach and good fracture reduction fixation are keys to obtain satisfactory curative effect.