髋臼后壁骨折合并髋关节后脱位诊疗失误及并发症分析

Analysis on the errors in diagnosis and treatment and complications for patients suffered from acetabular posterior wall fracture combined with dislocation of hip joint

目的探讨髋臼后壁骨折伴髋关节后脱位诊疗过程中失误原因及与术后并发症的关系。方法回顾性研究42例髋臼后壁骨折伴髋关节脱位患者的诊疗经过,并对术后发生的并发症进行分析。结果所有患者随访7个月-2年5个月,平均23个月,其中有4例患者出现髋关节异位骨化,2例出现医源性坐骨神经损伤,2例出现股骨头坏死,2例于内固定手术前复查CT发现髋关节仍处于后脱位状态。Matta影像学评分：优21例,良17例,可3例,差1例,优良率90.47%;关节功能Merled,Aubigne评分：优20例,良12例,可7例,差3例,优良率76.19%。结论整复定位,骨牵引操作不当及髋关节漏诊是诊疗失误的主要原因,延迟复位增加了术后股骨头缺血及异味骨化等并发症的发生率。

Objective To investigate the reasons which induced errors during the process of diagnosing and treating for acetabular posterior wall fracture combined with dislocation of hip jointand its association with postoperative complications. Methods A retrospective study ondiagnosis and treatment process for 42 cases of acetabular posterior wall fracture combined with dislocation of hip joint was done, and analyzed the occurrence of postoperative complications. Results Patients were followed up for at least 7 months and 29 months in maximum, and23 months on average. During the following up period four patients had hip heterotopie ossification, two eases suffered from iatrogenie nerve injury, two eases with femoral head necrosis, two cases were still with dislocation of hip jointunder CT scan after internal fixation. Matta imaging score demonstrated that excellent in 21 patients, fine in 17 cases,3 cases was just tolerablenessand 1 casewas poor, the excellent and good rate was 90.47%. Joint function Merled,Aubignescore suggested that 20 eases excellent, 12 cases good, 7 eases was tolerableness, 3 eases poor, excellent and good rate was 76.19%. Conclusions The entire complex positioning,improper skeletal traction operation and misdiagnosisof the hip were the main reasons for treatment failure, delayed reset increased the incidence of postoperative blood deficiencyand heterotopic ossification.