移位髋臼骨折合并不稳定骨盆骨折的手术治疗

目的探讨移位髋臼骨折合并不稳定骨盆骨折手术治疗方法。方法回顾性分析我院手术治疗的移位髋臼骨折合并不稳定骨盆骨折患者52例。其中髋臼骨折应用重建钢板或拉力螺钉内固定;骨盆后环损伤应用骶髂螺钉或骶髂关节前方钢板固定;骨盆前环损伤应用重建钢板内固定。结果52例随访完全,平均随访时间17个月。根据Matta的复位标准,解剖复位40例,占77%,满意8例,占16%,不满意4例,占7%。根据Harris髋关节功能评分标准和Majeed骨盆损伤疗效标准,优34例,占67%,良7例,占12%,可6例,占11%,差5例,占10%。术后主要并发症包括髋关节创伤性关节炎5例,4例BrookerⅡ级异位骨化,3例迟发性坐骨神经损伤。结论移位髋臼骨折合并不稳定骨盆骨折病情稳定后,应尽早手术治疗,尽可能解剖复位髋臼骨折,同时合理处理骨盆前后环损伤,其中髋臼骨折的损伤程度及其复位质量是决定远期疗效的主要因素。

Surgical treatment of displaced fracture of acetabulum associated with unstable pelvic fractures

Objective To discuss the surgical treatment of displaced fractures of acetabulum associated with unstable pelvic fractures.Methods This study examined retrospectively the 52 patients with displaced acetabular fractures associated with unstable pelvic fractures from January 1995 to January 2007,which were treated operatively.The patients with acetabular fracture were operated with internal fixation of reconstruction plate or lag screw.The patients with unstable pelvic fracture were operated with sacroiliac screw fixation and anterior sacroiliac plate fixation.Results All 52 patients were followed up.The average follow-up period was seventeen months.According to Matta's reduction criteria,anatomic in 40(77%),imperfect in 8(16%),poor in 4(7%).According to Harris hip evaluation and Majeed's pelvic injury evaluation,excellent in 34(67%),fine in 7(12%),common in 6(11%),and poor in 5(10%).The complications included traumatic arthritis of the hip(5 cases),heterotopic ossification(4 cases)and delayed nerve injury(3 cases).Conclusion It is necessary and important to simultaneously treat displaced acetabular fractures and unstable pelvic fractures for patients with displaced fracture of acetabulum associated with unstable pelvic fractures.