累及负重区残留移位对髋臼骨折术后髋关节功能的影响

Effect of Residual and Displacement Involved in Load-bearing Area on Function of Hip Joint in Patients after Acetabular Fracture

目的探讨累及负重区的残留移位对髋臼骨折术后髋关节功能的影响。方法选取2011年3月—2014年5月宝鸡市中心医院收治的髋臼骨折87例,根据骨折是否累及负重区分为负重组45例与非负重组42例,两组均采取切开复位钢板内固定术。比较两组术后切口愈合情况、骨折愈合时间、并发症发生率、解剖复位率、髋关节功能优良率。分析残留移位患者累及负重区、残留移位部位与术后髋关节功能的相关性。结果 2组切口一期愈合率、骨折愈合时间、并发症发生率及复位质量、髋关节功能比较差异均无统计学意义(P>0.05)。负重组台阶移位值与间隙移位均大于非负重组,髋关节功能较非负重组差(P<0.05)。负重组残留移位与髋关节功能呈正相关(r=0.813,P<0.001)。残留台阶移位与髋关节功能呈正相关(r=0.834,P<0.001),残留间隙移位与髋关节功能无明显相关性(r=0.341,P>0.05)。结论累及负重区的残留移位大小及部位是影响髋臼骨折术后髋关节功能的重要因素,建议术中仔细复位以提高解剖复位率,避免负重区残留台阶移位。

Objective To investigate effect of residual and displacement involved in load-bearing area on function of hip joint in patients after acetabular fractures. Methods A total of 87 patients with acetabular fractures admitted during March 2011 and May 2014 were divided into load group( n = 45) and non-load group( n = 42) according to whether the fractures had been involved in load-bearing area or not. Both groups were treated with open reduction and plate internal fixation,and then incision healing conditions,fracture healing time,incidence rates of complications,anatomical reduction rate and excellent and good rate of hip joint function were compared between two groups. Relationship between residual and displacement involved in load-bearing area and postoperative hip joint function were analyzed. Results There were no significant differences in incision primary healing rate,time of fracture healing,incidence rate of complications,reduction quality and hip joint function between the two groups( P > 0. 05). In load group,values of step shift and gap shift were significantly higher,while hip joint function was worse than those in non-load group( P < 0. 05).In load group,residual and displacement involved in load-bearing area was positively correlated with hip joint function( r = 0. 813,P < 0. 001),and residual step shift displacement involved in load-bearing area was positively correlated with correlation with hip joint function( r = 0. 834,P < 0. 001),while interspace shift displacement showed no obvious correlation with hip joint function( r = 0. 341,P > 0. 05). Conclusion The size and location of the residual displacement involved in load-bearing area are important factors affecting hip joint function after acetabular fractures. It is suggested that the intraoperative reduction should be performed carefully to improve the anatomical reduction rate and avoid residual and step shift displacement involved in load-bearing area