球面髂骨重建髋臼后壁粉碎性骨折并发骨缺损疗效观察

Clinical observation of autogenous spherical ilium reconstruction of acetabular posterior wall comminuted fracture associated with bone defect

目的：探讨自体髂骨球面成形移植重建髋臼后壁粉碎性骨折合并骨缺损的临床疗效。方法：2008-06—2012-12，共收治髋臼后壁粉碎性骨折合并骨缺损患者11例，男8例，女3例，平均年龄41．8岁。按A0分型：A1．1型3例，A1．2型6例，A1．3型2例。术前CT测量髋臼后壁骨缺损体积2～7cm。，平均3．8cm3。11例患者均行自体髂骨成形植骨重建髋臼后壁及内固定手术治疗。结果：11例患者随访时间12～42个月，平均23．45个月。根据改良Merle DAubignePostel和Thompson-Epstein临床评分标准，EYAubigne—Postel平均分为14．09±3．11；Thompson—Epstein的评估结果：优5例（45．4％），良4例（36．3％），可1例（9．0％），差1例（9．0％）。优良率为81．8％。结论：采用自体髂骨球面成形植骨治疗髋臼后壁粉碎性骨折合并骨缺损，可有效提高髋臼与股骨头配匹，增强关节稳定性，利于髋关节功能恢复。

Objective：To explore the clinical effect of autogenous ilium reconstruction of acetabular posterior wall comminuted fracture combined bone defect, so as to providing evidence for clinical practice. Method ： We retro- spectively reviewed a series of 11 patients diagnosed as acetabular posterior wall comminuted fracture combined bone defect from June 2008 to December 2012. Eight patients were males and three were females with a mean age of 41.8 years （range 21--67years）. According to AO classification three eases were type A1.1, six cases type A1. 2 ,and two cases type A1.3. The average bone defect volume of posterior wall aeetabulum was 3.8 cm3 （range 2- 9 cm3 ）. All patients were treated with autogenous ilium reconstruction of acetabular posterior wall and internal fix- ation. Result：Patients were followed up for 12 to 42 months,with an average of 23.45± 8.2 months. The average Merle d＇Aubigne Postel score was 14.09±3.11. According to the Thompson Epstein criteria, five （45.4 %） pa- tients had excellent results,four （36.3%） patients good,one （9.0%） patient fair,and one （9.0%） patient poor results. The rate of excellent and good cases was 81.8%. Conclusion：The technique of autogenous ilium reconstruc- tion of acetabular posterior wall comminuted fracture combined bone defect can improve the matching degree between femoral head and acetabulum,enhance joint stability,and contribute to recover the hip function.