髋臼骨折48例治疗体会

Treating Comprehension of 48 Cases with Acetabulum Fracture

目的 :探讨髋臼骨折诊疗方式的选择及远期并发症的预防问题。方法 :18例进行了保守治疗 (双方位骨牵引 ) ,3 0例进行了手术治疗。结果 :优 3 0例 ,良 9例 ,可 4例 ,差 5例 ,优良率 81.2 5 %。并发创伤性关节炎 18例 ,感染 2例 ,异位骨化 1例。结论 :正确判定骨折类型是治疗髋臼骨折的前提条件。横过髋臼顶负重部位、移位 <3mm的骨折、低位的横行骨折和低位的前柱骨折及任何有其他非骨折本身的不适合手术治疗指征的患者均应施行闭合治疗。采用双方位骨牵引治疗 ,即股骨髁上牵引加同侧大粗隆下外侧牵引。骨折移位 >3mm ,关节内有游离骨块和关节后方不稳是手术适应证。采用有限的显露和间接复位技术。准确恢复负重面的解剖关系可以有效防止创伤性关节炎发生。术中大量盐水冲洗 ,放置负压引流有防止并发感染和异位骨化的作用。有限显露和间接复位技术也是防止异位骨化的重要手段。

Objective: To discuss the choice of the way to diagnose and treat the acetabulum fracture, and the problems of preventing the complication. Methods:Eighteen cases were carried conservative treatment (both position bone traction), and 30 cases were operated on. Results: Thirty cases were evaluated excellent, 9 examples were evaluated well, 4 may, and 5 poor. The well developed rate was 81.25%. There were 18 examples had complication of traumatic arthritis, 2 examples infected, and 1 examples occurred heterotopic ossification. Conclusion: Determining the fracture type correctly is the premise condition to curing the acetabulum fracture. The cases with the fracture through the weight loading site on acetabular vertex? the cases with the displacement of less than 3mm? the cases with low transverse fracture together with low anterior column fracture and each cases with the signs unfitting to being operated except the fracture itself should all be carried closing treatment all. Carrying both position bone traction is tracting the supracondylar part of femur together with the inferolateral surface of greater trochanter of femur.Displacement of more than 3mm, with free bones in arthron and unstable base of arthron are adaptation signs for operation. Adopting limited exposure and indirect diaplasis, and reversing the anatomical relation of weight loading side can prevent the traumatic arthritis effectively. Washing with a lot saline in operation, and placing negative pressure drain have the effects to prevent the complication of infection and heterotopic ossification. Limited exposure and indirect diaplasia are important method to prevent the heterotopic ossification,too.