涉及髋臼四边体骨折的治疗体会

Treatment of Quadrilateral Body Involved the Acetabular Fracture

目的探讨采用髂腹股沟入路、Kocher-Langenbeck入路或联合入路切开复位骨盆重建钢板结合拉力螺钉内固定治疗涉及髋臼四边体骨折的临床疗效。方法自2006年5月至2011年4月我科治疗的24例涉及髋臼四边体骨折患者,其中男17例,女7例;年龄18～59岁,平均38.5岁。骨折按Letournel分类,后柱骨折2例,后柱伴后壁骨折2例,横形骨折3例,"T"形骨折3例,前柱伴后半横形骨折2例,双柱骨折12例。结果 24例均获得随访,时间6～36个月,平均21个月。临床疗效按照改良后的Modified d′Aubigne and Postel髋关节评分标准,优13例,良6例,可3例,差2例,优良率79.16%。结论髂腹股沟入路、Kocher-Langenbeck入路或联合入路骨盆重建钢板结合拉力螺钉内固定治疗髋臼四边体骨折,具有显露清楚、便于骨折复位、固定稳定、临床效果满意等优点,是治疗涉及髋臼四边体骨折合并股骨头中心脱位的有效方法。

Objective To investigate the clinical effect of ilioinguinal approach,Kocher-Langenbeck approach and combination approach for open reduction and pelvic reconstructive plate combined with lag screw internal fixation in the treatment of acetabular fractures involving quadrilateral body.Methods From May 2006 to April 2011 24 acetabulum quadrilateral body fracture patients were treatmented in our department（17 male,7 female）;The average age was 38.5 years old.According to Letournel classification,there were posterior column fracture in 2 cases,posterior column and posterior wall fracture in 2 cases,transverse fracture in 3 cases,T3 cases of anterior column fracture,with the second transverse fracture in 2 cases,double column fracture in 12 cases.Results 24 cases were followed up for 6 ～ 36 months（mean 21 months）.The clinical result was evaluated with the improved Modified D,Aubigne and Postel hip score standard.There were excellent in 13 cases,good in 6 cases,in 3 cases,poor in 2 cases.The excellent and good rate was 79.16%.Conclusion The pelvic reconstructive plate combined with lag screw internal fixation through ilioinguinal approach,Kocher-Langenbeck approach or a combined approach satisfactory treatment for the acetabulum quadrilateral body fracture with femoral head center dislocation.