严重粉碎性髋臼骨折的手术治疗

Surgical Treatment of Severe Comminuted Aetabular Fractures

目的 探讨严重粉碎髋臼骨折的手术治疗策略和方法。方法 89例复杂髋臼骨折采用重建钢板和拉力螺钉内固定 ,按照Letournel分类 ,后柱合并后壁骨折 8例 ,横形合并后壁骨折 18例 ,T形骨折 2 1例 ,双柱骨折合并后壁骨折 32例 ,前柱合并后半横形骨折 10例。K -L入路 2 2例 ,髂腹股沟入路 31例 ,延长髂股入路 4例 ,双入路 36例。结果 随访 3～ 36个月 ,按照d`AubigneandEpstein标准 ,优 6 4例 ,良 18例 ,可 7例 ,优良率 92 13%。深部感染 2例 ,坐骨神经损伤 2例 ,静脉血栓2例 ,中重度骨关节炎 2例 ,股骨头缺血坏死 2例 ,异位骨化 14例。结论 手术前明确骨折分类、手术时机适当 。

Objective To investigate the surgical strategy and methods of displaced complex acetabular fractures.Methods Eighty nine cases of complex type of acetabular fractures with dislocation were treated with open reduction and internal fixation using reconstruction plates and lag screws.Of the 89 cases,fractures of the posterior column and wall was found in 8 cases,transverse and posterior wall in 18 cases,T shaped in 21 cases,anterior and hemitransverse in 10 cases,and the other 32 cases were both column fractures combined with posterior wall fractures.Kocher Langenbeck approach was adopted in 22 cases,ilio inguinal approach in 31 cases,extended iliofemoral approach in 4 cases,and double approachs(K-L added up ilio inguinal)in 36 cases.Results All patients underwent average 21 months(6～36 months) follow up.Based on d′Aubigne and Epstein′S evaluation,64 patients achieved excellent results,and 18 good,7 fair.Excellent and good rate was 92 13%.Complications included of deep infection in 2 cases,nerve injury in 2,deep venous thrombosis in 2,moderate or severe osteoarthritis in 2,avascular necrosis of the femoral head in 2 case,heterotopic ossification occurred in 10 cases brooker grade Ⅰ～Ⅱ and 4 cases grade Ⅲ.Conclusion Correct classification of fracture before operation,appropriate selection of operative approach and satisfactory fracture reduction and reliable internal fixation and timely operation are key points to improve outcome of acetabular fracture.