陈旧粉碎性髋臼骨折手术重建修复的策略及预后

Strategy and prognosis of staleness comminuted acetabular fracture reconstruction and repair

背景:陈旧粉碎性髋臼骨折多为高动能严重复合损伤,现逐年增加,且无法早期手术。随着早期切开复位内固定手术的经验积累,对陈旧粉碎性髋臼骨折进行切开复位内固定重建手术势在必行。目的:探讨切开复位内固定手术重建修复陈旧粉碎性髋臼骨折的可行性、方法及疗效。方法:回顾性研究2003年10月至2010年6月应用先纠正髋臼周围骨盆骨折移位及股骨头臼关系,再重建修复髋臼关节面的方法治疗24例陈旧粉碎性髋臼骨折。骨折距手术时间3～6周,平均26.1天。分析手术时间、出血量及输血量、合并伤情况等。术后限制髋部活动4～6周,床上逐渐行关节功能锻炼,3月后下床扶拐活动,并逐渐负重。结果:随访10～36个月,平均15.6个月。关节面骨折复位质量采用Matta标准:解剖复位21髋,满意复位2髋,不满意复位1髋。采用改良Mered'Aubigne-Postel临床结果评分:优21髋,良2髋,差1髋。术后发生股骨头坏死1例(4.17%),异位骨化11例(45.83%),坐骨神经一过性麻痹6例(25%)。结论:先行瘢痕切除松解、整体复位固定髋臼关节外骨折、恢复头臼关系,再应用可吸收螺钉固定、植骨、骨软骨骨折块镶嵌挤压等方法修复碎裂关节面的手术方法治疗陈旧粉碎性髋臼骨折,可达到满意复位及关节功能恢复。

Background： Staleness comminuted acetabular fracture, a kind of severe high-energy complex injury, is increasing year by year and can not early treated by surgery. With the development of open reduction and internal fixation, it has become possi- ble for the treatment of severe acetabular fracture. Objective： The aim of the study is to explore the feasibility, operative procedure, and outcome of open reduction and inter- nal fixation for staleness comminuted acetabular fracture. Methods： From October 2003 to June 2010, 24 patients with staleness comminuted acetabular fracture were treated by re- duction and reconstruction. The mean duration from injury occurrence to surgery was 26.1 d （range, 3-6 weeks）. Hip activi- ty was prohibited for 4-6 weeks postoperatively. Joint fimctional exercises were conducted on the bed. Patients got out of bed and did proper exercises three month later. Results： The mean duration of follow up was 15.6 months （range, 10-36 months）. Joint surface reduction was assessed by Matta criteria： anatomical repositioning in 21 hips, satisfying in 2 hips, and dissatisfying in one hip. According to modified Mere d＇ Aubigne-Postel scoring for clinical results： excellent in 21 hips, good in 2 hips, and bad in one hip. Avascular necro- sis occurred in one patient （4.17%）, heterotopic ossification in 11 patients （45.83%）, and transient sciatic nerve paralysis in 6 patients （25%）. Conclusions： Our treatment experience is to clear away scar tissue firstly, and then to regain the relationship between femo- ral head and acetabulum, and restore fractured joint surface by absorbable screw fixation and bone graft for staleness comminuted acetabular fracture. The reduction and joint functional recovery are satisfactory.