手术与非手术复位法治疗髋臼后壁骨折的临床研究

Clinical analysis of treating posterior wall acetabular fractures by operation and non-operation reset method

目的探讨髋臼后壁骨折的临床诊断和治疗方法，并评价其临床疗效。方法选择金华市文荣医院2009年1月—2012年8月因髋臼后壁骨折入院的162例患者，根据严格的手术适应标准，选择符合手术者采用手术复位，其余选择非手术复位，手术组128例，非手术组34例。复位质量和X线片随访均按Matta标准评定，异位骨化采用Brooker分级法评估。结果162例患者均获得随访，随访时间为24～32个月，平均28个月。手术组124例（96．9％）复位愈合满意，非手术组32例（94．1％）复位愈合满意，2组骨折复位情况比较差异无统计学意义（P〉0．05）。根据Matta评定标准：手术组优良率为80．5％；非手术组优良率为55．9％，2组比较差异有统计学意义（P〈0．05）。异位骨化和创伤性关节炎发生率非手术组高于手术组，差异有统计学意义（P〈0．05）。2组在感染、股骨头坏死或下肢深静脉血栓和肺栓塞等并发症发生率差异无统计学意义。结论髋臼后壁骨折患者采用X线片、CT扫描等检查能获得较好的早期诊断。严格按照受伤分型尽快进行早期治疗，无论手术还是非手术治疗，都能达到较好的复位满意度。但由于非手术组后期功能恢复的优良率明显低于手术组且并发症的发生率较高，因此选择手术治疗可获得较好的疗效。

Objective To explore the diagnosis, treatment and clinical effect of posterior wall fractures of the acetabulum. Methods 162 cases of hospitalized patients, according to surgery standards strictly, 128 cases got surgical reduction, and 34 cases choosing non-surgical reduction. The quality of fracture reduction after treatment and the results of follow-up radiograph were assessed according to Matta＇ s standard. Ossification was assessed according to Brooker＇ s standard. Results 162 patients were received follow-up, time of 24 to 32 months, with an average of 28 months. 124 cases （96.9%） had reduction and healing,32 cases（94.1% ） in non surgical group had reduction and healing,two groups of fracture situation was no significant difference （ P 〉 0.05 ）. According to the Matta evaluation criteria： scores was 80.5 % ; non surgical group was 55.9%, comparing the two groups, there was statistically significant difference （ P 〈 0.05 ）. Heterotopic ossification and incidence of traumatic arthritis were higher than those of surgery group, the difference was statistically significant （P 〈 0.05）. Conclusion It was necessary to operate posterior wall fractures of the acetabulum which was diagnosed correctly through integrating radiograph and CT. According to the type of injury, both surgical and non-surgical treatment could achieve satisfactory results. But because of those who did not function recovery was significantly lower than the scores of the late and the incidence of complications was higher, so choosing the surgical treatment could obtain good curative effect.