髋臼骨折ABC损伤变数定位系统的设计与1122例多中心研究分析

目的：设计髋臼骨折ABC损伤变数定位系统并通过1122例髋臼骨折多中心分析研究,探索该系统的可行性与临床实用价值。方法：根据髋臼三柱壁概念,参考髋臼骨折多米诺骨牌效应所致的骨盆环损伤方向和股骨近端关节损伤程度,设A类为髋臼任何一柱、壁骨折;B类为任何二柱、壁骨折;C类为髋臼前、中（臼顶）、后柱/壁混合骨折。小写英文字母a、m、p,分别代表前、中、后柱/壁骨折。采取损伤变数分型：髋臼损伤变数,1系简单移位骨折;2系粉碎骨折;3系压缩性缺损。盆环损伤变数：α系骶髂关节/骶髂处骨折呈水平位分离变位;β系前者垂直方向分离变位;γ系耻骨联合分离/耻骨上、下支骨折变位;δ系αβγ综合性的浮动损伤。股近端关节损伤变数：Ⅰ系股骨头骨折;Ⅱ系股骨颈骨折;Ⅲ系股骨转子部骨折;Ⅳ系Ⅰ～Ⅲ混合性骨折。应用上述构成的髋臼骨折ABC损伤变数定位系统,统计1997年3月至2010年2月,1122例髋臼骨折,其中18例双侧髋臼骨折,共1140例髋。分析研究骨盆前后位片,髂骨、闭孔斜位片及2/3DCT资料。结果：1140例组别各损伤变数构成比：A类骨折237例（20.8%）,B类骨折605例（53.1%）,C类骨折298例（26.1%）。涉及前柱壁骨折808例,发生率为70.9%,中柱壁骨折507例,发生率为44.5%,后柱壁骨折1026例,发生率为90%。涉及髋臼变数1,即简单移位骨折203例（17.8%）;变数2,即粉碎性骨折516例（45.3%）;变数3,即压缩性骨折缺损421例（36.9%）;涉及骨盆环损伤249例,占总数21.8%;涉及股骨近端骨折75例,占总数的6.6%;双侧髋臼骨折与相关盆环、股骨近端变数组18例（1.6%）。1140例髋臼骨折之关键部位与疗效要素：涉及髋臼中（臼顶）柱/壁骨折507例（44.5%）;压缩性缺损421例（36.9%）;盆环变数249例（21.8%）;股近端关节变数75例（6.6%）;而相对简单的Aa/p1/2、Bap1/2型髋臼骨折486例（42.6%）。结论：研究表明髋臼损伤变数中粉碎压缩,尤其是压缩缺损骨折占重要比重,同时彰显了髋臼骨折合并骨盆环或股骨近端损伤变数并非少见。该研究揭示了髋臼骨折损伤变数之间的相互关系,其百分比表明了临床治疗的重点和要素：负重之臼顶44.5%;压缩之缺损36.9%;盆环之浮动21.8%;＂头-臼＂之双折6.6%。该系统在伤情评估、解剖定位、难度指数、选择对策、手术入路、疗效预后等方面,起到临床指导作用,创建了同类型骨折损伤变数的比较,为＂同质语言＂的交流,探索了新的途径。

Design of ABC damage variable and positioning system for acetabular fractures and 1122 cases of multi-center statistic analysis

Objective：To design ABC damage variable and positioning system for acetabular fracture and explore the feasibility and clinical practical value of the system through the multi-center analysis of 1122 acetabular fractures. Methods：According to acetabular three-column conception,and pelvic ring lesions damage direction caused by acetabular fracture domino effect and injury degree of proximal femur joint,it defined class A as any column acetabular fracture; class B as any two-column acetabular fracture; class C as front,dome and posterior mixture acetabular fracture. Lower case English letters a,m,p represented front,dome,posterior fracture,respectively. Acetabular damage variables：1 was simple displaced fractures;2 was comminuted fractures; 3 was compression fractures. Pelvic ring lesions damage variables：α was sacroiliac joints or sacroiliac fracture horizontal separation deflection; β was sacroiliac joints or sacroiliac fracture vertical separation deflection;γ was pubic symphysis separation/superior and inferior ramus of pubis fracture deflection; αβγδ was compound floating damage. Proximal humerus joint damage variables：Ⅰ was femoral head fracture; Ⅱ was femoral neck fracture; Ⅲ was intertrochanteric fractures of femur; Ⅳ was Ⅰ to Ⅲ compound fracture. The ABC damage variable positioning system for acetabular fracture was made up by the above-mentioned variables. The statistics from March 1997 to February 2010 showed 1122 cases acetabular fractures with 18 cases of double side acetabular fracture and 1140 cases of acetabular fractures. The pelvics anterior-posterior view,ilium and obturator oblique view,and 2/3D-CT materials were analyzed and researched. Results：Each damage variables distribution situation in 1140 cases of acetabular fracture involved A in 237 cases （20.8%）,B in 605 cases （53.1%）,C in 298 cases （26.1%）;front column fracture in 808 cases（70.9%）,dome fracture in 507 cases （44.5%）,posterior fracture in 1026 cases（90%）. Acetabular variables：variabe 1 in 203 cases of simple displaced fracture （17.8%）;variabe 2 in 516 cases of comminuted fracture（45.3%）;variabe 3 in 421 cases of compression fracture （36.9%）; 249 cases of pelvic ring lesions damage （21.8%）,75 cases femoral head fracture （6.6%）; 18 cases of double side acetabular fracture and relative pelvic ring and proximal humerus joint variables （1.58%）. Key part and curative effect elements of 1140 cases acetabular fracture：507 cases of dome or posterior acetabular fracture（44.5%）; 421 cases of compression fracture（36.9%）;249 cases of pelvic ring variables（21.8%）; 75 cases of proximal humerus joint variables（6.6%）;486 cases of simple Aa/p1/2,Bap1/2 acetabular fracture（42.6%）. Conclusion：Compression fracture,especially defected compression fracture,takes important part in acetabular damage variables,and also presents that acetabular fracture with pelvic ring and proximal femoral damage variables are not rare at all. The relationship of the acetabular fracture damage variables,and its percentage shows the key points and elements in clinical treatment：weight-bearing to dome accounts for 44.5%;compression to defects account for 36.9%,pelvic ring to float accounts for 21.8%;dome fracture to double side fracture account for 6.6%. The system has significant guiding effects on clinic in terms of evaluation of injury severity,anatomic localization,difficulty index,alternative strategy,operative approach,effect of treatment,and prognosis. And the most important thing is that the system creates the comparison of damage variables in same type of fracture and the communication of homo-language and explores a new method.