术后开始下地时间对髋臼骨折合并同侧股骨骨折术后疗效的影响

Effect of postoperative ambulation starting time on outcome of patients with acetabular fracturescombined with ipsilateral femoral fractures

目的观察髋臼骨折合并同侧股骨骨折患者术后远期髋关节功能，研究术后开始下地（部分负重）锻炼时间对髋关节功能恢复的影响。方法选择2007年1月-2011年6月收治的髋臼骨折合并同侧股骨骨折患者37例，其中合并股骨头骨折16例，合并股骨干骨折17例，合并大转子骨折2例，合并股骨远端骨折2例。根据术后开始下地（部分负重）锻炼时间将患者分为三组：A组（≤2个月），B组（≤3个月），C组（〉3个月）。用Harris评分系统评价患者远期髋关节功能，分析各组Harris评分优良率的差异。结果37例获得随访，随访时间14～66个月，平均44．9个月，术后复查骨折均愈合。患髋功能优良率A组为87％（13／15），B组为42％（5／12），C组为40％（4／10），A组明显优于B、C两组（P〈0．05）。结论髋臼骨折合并同侧股骨骨折坚强固定及早期下地（部分负重）锻炼有利于髋关节功能的恢复。术后2个月内开始下地（部分负重）锻炼的患者髋关节功能恢复优于2个月后开始的患者。

Objective To investigate relationship between start time of postoperative ambulation （partial weight bearing） and hip joint function rehabilitation in patients with acetabular and ipsilateral femoral fractures by studying the late hip joint function. Methods The study involved 37 patients with acetabular and ipsilateral femoral fractures treated from January 2007 to June 2011, including 16 patients with associated femoral head fractures, 17 femoral shaft fractures, two greater trochanteric fractures, and two distal femoral fractures. According to the starting time of postoperative ambulation （partial weight bearing）, the patients were divided into three groups, ie, Group A （≤ 2 months）, Group B （≤ 3 months） and Group C （ 〉 3 months）. Harris score system was used to evaluate late hip function of the patients. Further, differences of Harris excellent-good rate among groups were analyzed. Results All patients were followed up for 14456 months （mean 44.9 months）. Fractures were all healed based on postoperative examination. Excellent-good rate of hip function was 87% （13/15） in Group A, 42% （5/ 12 ） in Group B, and 40% （4/10） in Group C, with significantly superior results in Group A than that in Groups B and C （P 〈 0.05）. Conclusions Stable internal fixation and early postoperative ambulation （ partial weight bearing） favors hip function rehabilitation in patients with acetabular and ipsilateral femoral fractures. Patients who start ambulation （partial weight bearing） within two months after operation obtain better hip function recovery than those who start ambulation two months later.