自体游离髂骨移植重建髋臼后壁陈旧性骨折缺损

Old traumatic posterior acetabular defects reconstructed with iliac crest autograft

目的探讨用自体游离髂骨移植重建髋臼后壁陈旧性骨折缺损的方法。方法手术中先去除残留的髋臼后壁骨折块 ,使脱位的股骨头复位。取长 6～ 8 cm、宽 3～ 4 cm的自体游离髂骨植于髋臼后壁基底处 ,用 2～ 4枚螺钉固定 ,以重建髋臼后壁。自 1990年 3月～ 1998年 3月 ,用此法治疗 6例车祸伤患者；男 4例 ,女 2例 ;年龄 8～ 45岁 ,平均 32岁。全部病例从骨折至重建术的时间为 3～ 11个月 ,平均 7个月。随访 2～ 10年。结果无一例患者发生手术后并发症 ,髋关节功能均恢复良好 ,可不扶拐行走，轻度跛行，长距离行走后仅有轻微疼痛。 X线片显示股骨头与重建的髋臼虽未达到解剖学匹配 ,但股骨头无再脱位。其中髋关节轻度间隙狭窄无退变者 1例 ,间隙狭窄伴轻度退变者 3例 ,股骨头轻度致密改变者 2例。结论自体游离髂骨移植重建术 ,是治疗年轻患者髋臼后壁陈旧性骨折缺损的有效方法 ,它可以恢复髋关节的后方稳定 ,防止股骨头再脱位 ,并为日后全髋关节置换术的臼杯固定提供准备。

Objective To describe the surgical technique for treatment of old traumatic posterior acetabular defects. Methods From March 1990 to March 1998, 6 patients were treated with a full thickness iliac crest autograft to reconstruct their posterior acetabular defects. There were 4 males and 2 females, the average age of the patients was 32 years. The acetabular defects were caused by traffic accident and delayed in treatment for 3 to 11 months. Results The duration of follow up was 2－ 10 years， the function of the hip joints were good in all of the patients, according to the criterion of d Aubigne six points. X－ ray film revealed that although the femoral head was not in exact congruence with reconstructed acetabulum, yet there was no dislocation. Slight degeneration was found in 3 cases. Conclusion Although this procedure did not exactly reproduce the anatomy of the hip joint, it restored the posterior stability, provided bone stock for the hip joints and prevented dislocation of the femoral head. So this procedure is useful for late total hip arthroplasty.