关于复合型髋臼骨折的临床研究

Clinical Study of Complex Acetabular Fracture

目的 :提高对复合型髋臼骨折的诊断与治疗水平。方法 :总结 1997～ 2 0 0 0年 5月对 2 5例有移位的复合型髋臼骨折进行手术治疗的经验。按Letournel-Judet骨折分型 :髋臼后壁骨折伴后柱骨折 6例 ,前柱骨折伴后半横段骨折 6例 ,“T”型骨折 4例 ,双柱伴后壁骨折 9例。根据不同骨折类型 ,分别采用Kocher -Langeenbeck入路、髂腹股沟入路、髂股入路、扩展的髂股入路及前后联合入路进行骨折复位 ,均采用骨盆重建钢板和螺丝钉固定。结果 :2 5例患者 ,平均随访时间 18.4个月 ( 6～ 2 3个月 )。根据Matta评分 ,优 13例 ( 5 2 % ) ,良 8例 ( 32 % ) ,一般 2例 ( 8% ) ,差 2例 ( 8% )。并股骨头坏死 4例 ( 16 % )。异位骨化 3例 ( 12 % ) ,无手术死亡及感染发生。结论 :术前正确分析骨折类型 ;

Objective:To improve treatment of complex acetabular fracture.Methods:From 1996 to 2000,25 patients with complex acetabular fractures were operated in our hospital.Based on Letounel-Judet's classification,6 were combined fractures of the posterior column and wall.6 were anterior column fractures with a hemitransverse posterior fracture,4 were T-type fractures and the other 9 were both-column fractures combined with posterior wall fractrues.We achieved reduction of fracture through Kocher-Langenbeck with posterior wall fractures.We achieved reduction of fracture through Kocher-Langenbeck approach.ilioinguinal approach,iliofemoral approach,extensive iliofemoral approach,or combined anterior and posterior approaches accoding to different types of fractures,fixed with pelvic reconstruct plates and screws.Results:All patients underwent average 18.4 months (6～23 months)follow-up.Based on Matta's evaluation ,13 patients achieved excellent results (52%),and 8 good(32%),2 fair (8%),2 poor (8%).No operative death and infection,whereas avascular necrosis occcured in 4 patients (16%) and heterotopic ossification occurred in 3 patients (12%).Conclusions:Correct classification of fracture before operation,appropriate selection of operative approach and timely operation are key points to improve outcome of acetabular fracture.