髋关节中心性骨折脱位的外科治疗

目的探讨髋关节中心性骨折脱位的诊断、分类及外科治疗的特点。方法采用回顾性研究方法对髋关节中心性骨折脱位的外科治疗病例进行总结分析。结果 8例髋关节中心性骨折脱位均为臼底部骨折并股骨头中心型脱位突入盆腔,其中仅累及臼底部骨折3例,臼底部骨折合并髋臼前柱骨折2例,臼底部骨折合并髋臼前柱骨折及前壁骨折3例。8例均采用术前下肢股骨牵引使脱位的股骨头复位及改良扩大的髂股入路进行髋臼底骨折的切开复位钢板螺丝钉内固定术,其中2例臼底破损严重的病例采用取带缝匠肌髂骨骨瓣植骨重建术。髋臼骨折复位按Matta标准,术后解剖复位4例,满意复位4例,无不满意复位。结论髋关节中心性骨折脱位为髋臼较少见的严重损伤。对中心性脱位的股骨头宜采用三向分力的股骨牵引进行复位,因髋臼底位置深在手术复位较困难,故采取髂股手术入路,直视下可显露髋臼底骨折处。采用重建钢板进行骨折固定可确保髋臼内壁的光滑,髋臼底破损严重病例采用带肌蒂髂骨骨瓣植骨可起到重建臼底及加速骨折愈合的目的 。

Surgery Treatment of Central Fracture-Dislocation of the Hip Joint

Objective To study characteristics of surgery treatment of central fracture-dislocation of the hip joint.Methods 8cases of central fracture-dislocation of the hip joint treated from 2002 to 2008 were studied retrospectively.Results The fractures were generally intraarticular and almost invariably involve the dome of acetabulum.8 cases were treated by open reduction and internal fixation with reconstruction plates,2 cases of damaged acetabular dome were reconstructed by muscle pedicel iliac bone transplant.4 cases got anatomical reduction,4 got satisfactory result radiographically.Conclusion Central fracture-dislocation of the acetabulum is an uncommon and severe traumatic lesion of the pelvis.Closed manipulation followed by skeletal traction was essential to attain and maintain congruity of the weight-bearing dome with femoral head before surgical treatment.Surgical reduction of these fracture-dislocation is a major and difficult procedure and it must be performed under optimal conditions.The anterior iliofemoral approach can easily expose the medial aspect of the acetabular dome.