手术治疗复杂髋臼骨折临床分析

Clinical analysis on surgical management of complex fractures of acetabulum

目的:探讨手术治疗32例复杂髋臼骨折的临床效果。方法:采用切开复位内固定术治疗复杂髋臼骨折32例中,Kocher-Langenbeck(K-L)入路15例,前方髂腹股沟入路6例,前后联合入路11例。均以重建钢板作内固定。结果:术后平均随访22个月,切口均一期愈合。骨折复位质量按照Matta标准,解剖复位17例,满意复位12例,不满意复位3例。依据改良的Merle d'Aubigne-postel的评价标准,优15例,良10例,可5例,差2例,优良率为78.1%。术中出现坐骨神经损伤l例,术后出现创伤性关节炎8例,异位骨化3例,股骨头坏死2例,后期行全髋关节置换术1例。结论:术前明确复杂髋臼骨折的分型、选择正确的切口、注意复位顺序和方法、正确安置内固定材料为手术成功的关键。

Objective： To investigate the efficacy of surgical management of 32 cases of complex fractures of acetabulum . Meth- ods ： A retrospective study was carried out with 32 cases of complex fractures of acetabular （ Letournel and Judet classification） . Surgical management was performed through Kocher - Langenbeck approach （15 cages）, ilioinguinal approach （6 cases）, combined anterior and posterior approach （11 cases） . Following satisfied reduction, the fractures were fixed with reconstructive plates. Results： Patients were evaluated with an average follow - up time of 22 months （6 to 60 months） . Concerning the results of reduction （ Matta radiographic score ）, 17 cages and 12 cases achieved anatomical and satisfied reduction respectively, and 3 got unsatisfied reduction. Functional eval- uation （Merle d＇ Auhigne and Postel clinical evaluation） revealed that 15 cases and 10 cases achieved excellent and good outcome re- spoctively, and 5 and 2 got fair and poor results respectively. Complications included femoral head necrosis （2 cases）, myositis ossifi- cans （3 cases）, osteoarthritis （8cases） . Conclusions： Classification for acetabular fractures , surgical timing, approach, fracture re- duction and fixation are essential for the surgical management of complex fractures of acetabulun.