移位髋臼骨折治疗方法探讨及疗效分析（附33例报告）

【目的】探讨移位髋臼骨折的手术方法与疗效。【方法】回顾性分析2000年10月至2006年6月切开复位内固定治疗移位髋臼骨折33例，按Letournel—Judet分型简单骨折23例，复杂骨折10例。Kocher-Langenbeck入路25例、髂腹股沟入路5例、前后联合入路3例。首先处理关节腔内游离骨块，将负重区关节软骨下压缩骨折或翻转骨折复位，然后纠正骨折端旋转分离移位，复位后采用重建钢板内固定。[结果]30例患者随访13～80个月（平均51个月），根据Matta解剖学评分，解剖复位28例，复位欠佳3例，复位不满意2例；根据D’Aubigne-Postel功能评定标准：优20例，良6例，可4例，差3例。【结论】移位髋臼骨折应尽早手术，骨折类型、股骨头软骨面损伤程度、手术时间以及骨折复位质量是影响预后的主要因素。

Analysis of Clinical Outcome and Surgical Procedures for Displaced Acetabular Fractures

[Objective]To discuss the clinical outcome and surgical procedures for displaced acetabular fracture. [Methods]From October 2000 to June 2006, 33 cases with displaced acetabular fracture received surgical therapy. There were 28 cases with simple type of fractures and 10 cases with complicated type. KocherLangenbeek approach was applied for 25 cases,ilio-inguinal approach for 5 and anterior associated with posterior approach for 3. At first, free fracture fragments in articular cavity were removed and compressed or reversed sub-cartilage fractures under arthrodial cartilage in the area of weight loading were reset, then the rotated and apart displacement was corrected. After reposition, internal fixation with plate was done for reconstruction. [Results]Thirty cases were followed up from 13 to 80 months with an average time of 51 months. They were evaluated according to Matta anatomic criteria, 19 cases with anatomic reduction, 12 cases with satisfied reduction, 2 cases with unsatisfied reduction. According to D＇Aubigne-pestel criteria for joint functions, 20 cases were excellent, 6 fine, 4 fair and 3 poor. [Conclusion]Operation for displaced acetabular fractures should be performed as soon as possible. Letournel-Judet classification of fractures, damaged degree of femoral head cartilage, operation time and the quality of reduction are major factors of their prognosis.