累及负重区髋臼骨折的手术治疗

The operation of acetabular fractures involving weight bearing area

目的探讨累及负重区髋臼骨折的手术治疗方法和疗效。方法对16例累及负重区髋臼骨折患者,明确分型后分别采用K-L入路10例、髂腹股沟入路1例、前后联合入路5例,应用重建钢板进行内固定治疗。结果 16例均获随访,时间6～48个月,骨折3～5个月均骨性愈合。术后骨折复位质量按Matta标准评估:解剖复位9例,满意复位6例,不满意复位1例。髋关节功能按D'Aubigne-Postel标准评估:优5例,良8例,可2例,差1例。术后发生创伤性关节炎3例,异位骨化1例。结论术前正确掌握负重区情况及骨折分型、选择恰当的手术时机及入路、术中良好的关节面重建及复位、采用简单有效的固定、积极预防并发症是提高该型骨折疗效的关键。

Objective To investigate the surgery treatment of acetabular fractures involving weight bearing area. Methods 16 c.ases of aeetabular fractures involving weight bearing area with dislocation were treated with open re- duction and internal fixation with reconstruction plates. Kocher-Langenbeek（K-L） approach was adopted in 10 cases, ilio-inguinal approach in 1 case,and anterior combined posterior approach in 5 cases. Results 16 cases were fol lowed up for 6 - 48 months. All fractures got healing in 3 - 5 months. Reduction quality were assessed with Matta ra- diographic grade： excellent in 9 cases,good in 6,and poor in 1. According to the D＇Aubigne -Postel function of hip joint,5 cases were excellent,8 good,2 fair,and 1 poor. Traumatic arthritis was found in 3 cases,heterotopic ossifica- tion in 1 ease. Conclusions Preoperative correct grasp of the weight bearing area and the type of fracture, choose the appropriate timing of surgery and approach, good articular surface reconstruction and reset, simple and effective fixed,active prevention of complications are keys to improve the efficacy of this type of fracture.