112例髋臼骨折手术治疗结果分析

目的：通过对髋臼骨折手术治疗结果的分析和总结，以期进一步提高其治疗效果。方法：112例髋臼骨折患者，男94例，女18例，平均年龄37．6岁。均按Letournel和Judet的髋臼骨折分类法进行分型；所有新鲜骨折受伤距手术的平均时间为9.5d，常用手术入路为Kocher-Langenbeck入路，髋腹股沟入路和前后联合入路，采用专有器械及骨盆重建和螺丝钉对骨折进行复位和固定。结果：平均随访时间为45．7个月（6－93个月），根据改良的Merle d‘Aubigne和Postel的髋臼骨折临床结果评分标准，本组优35例，良47例，一般18例，差12例，优良率为73．2％。股骨头坏死8例，无一例死亡，感染及不愈合。结论：及时手术，解剖复位，早期功能锻炼，术者的经验以及对合并损佃的积极治疗是获得良好临床结果的关键。     

Interobserver agreement for Letournel acetabular fracture classification with multidetector CT: are standard Judet radiographs necessary?

PURPOSE: To retrospectively evaluate interobserver agreement for Letournel acetabular fracture classification with radiography alone and multidetector computed tomography (CT) alone and to retrospectively assess whether standard Judet views lead to a change in the classification. MATERIALS AND METHODS: Institutional review board approval was obtained; informed consent was not required for this HIPAA-compliant study, which included 101 imaging studies performed in 99 patients (78 male, 21 female; mean age, 43 years; age range, 15-86 years) with acetabular fractures. Two musculoskeletal radiologists independently classified the fractures with radiography alone and multidetector CT alone. Multiplanar reformatted and three-dimensional (3D) CT images were reviewed at a computer workstation. Readers were shown radiographs at the end of multidetector CT image reading to see if this would change the multidetector CT-based classification. kappa Values were calculated to assess interobserver agreement. For surgically treated patients, the McNemar test was used to compare the accuracy of readers' classifications. The reference standard was a combination of preoperative radiographic and multidetector CT image findings and intraoperative findings. RESULTS: Interobserver agreement was moderate (kappa = 0.42) with radiography and substantial (kappa = 0.70) with multidetector CT. Multidetector CT classification was changed in two cases (one case for each reader) after standard Judet views were added. In 73 surgically treated patients, agreement with the surgeons' classification was higher with multidetector CT than with radiography (P < .01 for one reader, P = .06 for the other reader). CONCLUSION: There is substantial interobserver agreement for Letournel acetabular fracture classification with multiplanar reformatted and 3D multidetector CT images. Standard Judet pelvic radiographs add little information for changing the multidetector CT classification.     

Evaluation of acetabular fractures with two- and three-dimensional CT.

The authors applied a widely used radiographic system of classifying acetabular fractures to axial computed tomographic (CT) scans and three-dimensional reconstructions in over 100 cases. In the classification system, fractures are analyzed according to the extent of involvement of two acetabular columns--the posterior and the anterior. To provide a better understanding of the CT anatomy of the acetabulum, the authors defined the boundaries of the columns on axial CT scans. They illustrated the most common fractures (posterior wall, transverse, transverse with posterior wall, and both columns) with radiographs, axial CT scans, and three-dimensional reconstructions. Axial CT scans readily demonstrated the fractures and presence of intraarticular fragments. Three-dimensional images helped in understanding the precise plane of the fracture, the degree of disruption of the articular surface, and spatial relationships of fragments. Although present three-dimensional CT is not without limitations, the authors believe that the technique is valuable and that, in their experience, it has facilitated preoperative planning.     

髋臼骨折合并股神经损伤相关因素分析

目的 分析髋臼骨折合并股神经损伤的原因，以期进一步提高临床诊治水平。方法 1996年1月-2004年11月，共手术治疗髋臼骨折146例，其中6例合并股神经损伤，根据临床表现、CT及三维重建分析股神经损伤的原因。按Letournel和Judet的髋臼骨折分类法进行分类，双柱骨折2例，横形伴后壁骨折1例，因骨折形成的巨大血肿压迫股神经，致股神经损伤；前壁骨折伴股骨头前脱位1例，髋臼前柱陈旧性骨折合并耻骨上支骨折1例，骨折端直接挫伤股神经；前柱骨折合并髂骨翼骨折1例，因术中牵拉损伤股神经。5例患者给予血肿清除、神经束减压、神经外膜松解去除病因，1例行保守治疗。结果本组6例患者随访1—3年，平均随访1．8年。5例患者股四头肌肌力从术前1—2级恢复至4—5级，1例从伤后2—3级恢复至5级，伸膝功能正常，可正常行走。4例患者感觉功能完全恢复，1例患者随访2年后仍有大腿下2／3前方及小腿内侧感觉减退；另有1例牵拉伤患者肌力恢复正常，随访1．2年后仍存在感觉障碍。结论 髋臼骨折合并股神经损伤临床上少见，复杂髋臼骨折应高度警惕有无股神经损伤；髂腰肌周围血肿形成及骨折块直接损伤是髋臼骨折合并股神经损伤的常见原因；医源性损伤需引起重视。     

髋臼骨折39例临床总结

对髋臼骨折39例进行了分析和讨论,并对其分类提出了适合中国特点的简单分类方法,37例获得了随访,其中随访10年以上者14例,最长时间29年,均获得较满意的结果。认为手术切口选择及手术器材是手术成功的关键。     

3D CT versus axial helical CT versus conventional tomography in the classification of acetabular fractures: a ROC analysis

AIM: To assess the diagnostic power of three-dimensional computed tomography (3D CT), axial helical computed tomography (CT) and conventional tomography in the classification of acetabular fractures by interdisciplinary review. MATERIALS AND METHODS: Receiver operating characteristics (ROCs) were assessed for two radiologists and two surgeons blinded to the presence of acetabular fractures in an animal model (a total of 62 porcine hips, 40 of them with artificial acetabular fractures). Main target parameter was the diagnostic accuracy in the classification of the artificial fractures following Judet et al. RESULTS: ROC analysis for radiologists showed A(z) values of 0.83 for 3D CT, 0.81 for axial helical CT, and 0.78 for conventional tomography; differences between the three techniques were not significant (P = 0.46-0.73). A(z) values for the surgeons were 0.87 for 3D CT, 0.68 for axial helical CT, and 0.60 for conventional tomography; 3D CT was significantly better than axial helical CT (P = 0.01) and conventional tomography (P = 0.001). The differences between axial helical CT and conventional tomography were not significant (P = 0.37). CONCLUSION: Acetabular fractures are best classified by 3D CT, followed by axial helical CT and conventional tomography when assessed by surgeons. 3D CT did not provide any additional significant benefit in the classification performed by radiologists.     

螺旋CT三维及四维成像在髋臼骨折中的应用

目的：探讨髋臼骨折中三维及四维CT重建技术的方法及临床应用价值。方法：32例髋臼骨折患者进行螺旋CT扫描，并通过多平重建法（MPR），三维表面遮盖法（SSD）及容积重建技术（VRT）观察损伤细节，对骨折进行临床分型。其中11例术后进行内固定复位及关节置换的疗效观察。结果：32例中MPR，SSD显示骨折28例，有4例未显示全部骨折线；SSD显示骨折立体效果优于VRT，对明显移位旋转的骨折显示清晰。VRT显示全部骨折，且在显示骨折细微结构和无移位骨折方面优于SSD，并可立体直观显示术后固定位置及复位效果。结论：螺旋CT，MPR，SSDVRT技术是诊断髋臼骨折的有效手段，对诊断复杂性髋臼骨折应作为首选，VRT技术对髋臼骨折手术方案制定及术手疗效判断有较高的价值。     

X-ray computed tomography in fractures of the acetabulum

Radiographic assessment of these fractures remains difficult. Conventional techniques according to Letournel show the lesions but not to the best advantage, for instance the "congruency" of femoral head with acetabulum. 54 CT scan were performed (1982-1984) every time a doubt was persisting. Incarcerations of fragments, impactions of the acetabulum, sacro-iliac joint disjunctions, congruency and lesions of femoral head are much better seen with scanner. In planing the surgical therapy (or orthopedic), CT scan add a great deal to the information and dramatically improves the results.     

Acetabular fractures revisited: part 2, a new CT-based classification

OBJECTIVE: The objective of this investigation was to provide a new CT-based classification of acetabular fractures. MATERIALS AND METHODS: The axial CT scans of 112 randomly selected acetabular fractures in patients admitted to a level 1 trauma center between January 1998 and December 2000 were analyzed by an experienced orthopedic trauma surgeon and two experienced emergency radiologists. When available, 3D reformatted images were analyzed as well. The fracture pattern for each acetabular fracture, with respect to column walls and extension beyond the acetabulum, when present, was recorded. Fracture comminution was not a defining characteristic. RESULTS: Analysis of the 112 acetabular fracture patterns showed that each fracture fell into one of four broad categories. Category 0 included wall fractures only. Category I included acetabular fractures limited to a single (anterior or posterior) column. Category II fractures included those involving both the anterior and posterior columns; category II fractures were further subdivided into those with no fracture extension beyond the acetabulum, those with superior or inferior extension, and those with both superior and inferior extensions beyond the acetabulum. Category III fractures included only the "floating" acetabulum, which is defined as an acetabular fracture in which the acetabulum is separated from the axial skeleton both anteriorly and posteriorly. CONCLUSION: The axial CT display of acetabular fracture patterns provides a basis for a classification of acetabular fractures that is simple, unambiguous, readily understood by both radiologists and orthopedic surgeons and provides clear direction for both diagnosis and surgical treatment planning. Category and subcategory fracture specificity creates a mechanism for intra- and interdepartmental postoperative assessment of any of the individual acetabular fracture types.     

有移位的髋臼骨折的治疗

目的：探讨有移位的髋臼折的最佳治疗方法。方法：总结1993年4月－2000年1月62例有移位的髋臼骨折进行治疗的经验。手术治疗组47例，按Judet等方法对骨折进行分型，46例根据分类结果选用适当的手术入路，行切开复位内固定，1例行全髋置换术。非手术治疗组15例，予以股骨髁上牵引和延迟髋关节活动及负重。结果：手术治疗组47例中，41例获随访（87．2％）。Matta影像学评分：优18例，良19例，一般1例，差3例；Matta临床评分：优16例，良18例，一般5例，差2例。非手术治疗组15例中，11例获随访，其中1例死亡。Matta影像学评分：优2例，良2例，一般3例，差3例，Matta临床评分：优2例，良1例，一般4例，差3例。结论：对于有移位的髋臼骨折，手术治疗优于非手术治疗，是最佳的治疗方法。     

Showing acetabular trauma with more clarity, less pain.

Standard radiographic projections may not provide a complete diagnosis of acetabular fractures, which often are the result of an automobile accident or other injury applying severe force to the femur. The Judet oblique projection of the pelvis and a variation described by the authors reduces patient risk and discomfort while demonstrating fractures not clearly seen on routine radiographs.     

Computed tomography in acetabular trauma

In a retrospective study of 16 acetabular fractures computed tomography (CT) clarified the type and extent of the injury. Computed tomography demonstrated intra-articular fragments of varying size in seven out of eight patients with fractures of the posterior acetabular margin. Abnormalities of the femoral head were also shown in six patients and the possible aetiology of these is discussed. The additional information provided by CT is likely to help in the management of patients with acetabular injuries.     

Stereoscopic 3D CT vs standard 3D CT in the classification of acetabular fractures: an experimental study

The accuracy of stereoscopic and standard three-dimensional (3D) CT in the classification of acetabular fractures was compared. A receiver operating characteristic (ROC) analysis was performed by two radiologists and two surgeons blinded to the presence of acetabular fractures in an animal model (a total of 62 porcine hips, 40 with artificial acetabular fractures). Classification of acetabular fractures was adopted from the literature. Interpretation was performed on a workstation using two specific volume rendering algorithms; unshaded and shaded bone. The ROC analysis did not demonstrate any benefit in stereoscopic 3D CT compared with standard 3D CT.     

Utility of roof arc measurements in acetabular fractures

For patients with acetabular fractures, the extent to which a fracture involves the weight-bearing dome has been estimated with the “roof arc” measurement obtained on radiographs and computed tomographic (CT) studies. We present the method for measuring the roof arc on radiographs and estimating this arc on CT scans. We also studied the utility of these roof arc measurements for predicting surgical vs. conservative management. Thirty-five patients with transverse or T-shaped acetabular fractures were reviewed. Roof arc measurements were performed on radiographs and CT scans. The clinical record for each patient was reviewed to determine whether the patient had been treated conservatively or surgically. Patients treated operatively for their acetabular fractures had a smaller roof arc measurement, as measured on radiographs, when compared to those patients treated nonoperatively. CT estimation of the roof arc measurement also was different between the two groups. We conclude that roof arc measurements are useful to further characterize patients with acetabular fractures.     

髋臼骨折手术入路选择策略

髋臼骨折的损伤机制为股骨头撞击髋臼导致的髋臼骨性结构破坏,手术日的是重建髋关节的头臼匹配关系并维持稳定.由于髋关节的特殊解剖结构,股骨头的遮挡使其前后面不能相互照应,因此手术入路的选择关系到手术区域显露、骨折复位质量、固定效果,直接影响手术疗效;合理的手术入路选择在手术时间、术中出 血、手术创伤及手术并发症等方面均有较...     

Acetabular fractures revisited: part 1, redefinition of the Letournel anterior column

OBJECTIVE: The objective of part 1 of this study is to redefine the Letournel anterior column on the basis of developmental and adult pelvic skeletal anatomy. MATERIALS AND METHODS: The axial CT scans of 112 randomly selected patients with acetabular fracture or fracture-dislocations admitted to a level I trauma center between January 1998 and December 2000 were analyzed by an experienced orthopedic trauma surgeon and two experienced emergency radiologists. When available, 3D reformatted images were analyzed as well. The discrepancy between the Letournel definition of the anterior and posterior columns became readily apparent. Standard text books of anatomy and surgical anatomy were referenced relative to the embryologic and adult components of the acetabulum. RESULTS: The anterior column is redefined with its superior border being the anatomic arcuate and iliopectineal lines, thereby coinciding with the superior border (arcuate line) of the Letournel posterior column. CONCLUSION: Redefinition of the anterior column eliminates diagnostic ambiguity of the Letournel elementary anterior column fracture as well as the Letournel associated anterior column or wall with hemitransverse fracture. The redefined anterior column is integral to the CT-based classification described in part 2 of our study.     

成人髋臼发育不良性骨关节病的X线及CT表现分析

目的:探讨成人髋臼发育不良性骨关节病的X线及CT表现特征。方法:对73例92个成人髋臼发育不良性骨关节病的X线及CT资料进行回顾性分析,73例均拍摄标准的骨盆前后位X线片,42例行CT扫描。X线片上测量反映髋臼发育的指标:外侧中心边缘角(LCE角)、臼顶倾斜角(AI角)、髋臼角(Sharp角)及股骨头突出指数(FEI)。结果:92个成人髋臼发育不良性骨关节病的X线改变为:髋臼发育不良及继发性骨性关节炎,均符合髋臼发育不良的测量指标。42例53个髋CT显示髋臼顶发育不良16髋,髋臼前部发育不良28髋,髋臼前后部均发育不良9髋。结论:髋臼浅小、倾斜及髋臼关节面下囊变、股骨头骨赘是成人髋臼发育不良性骨关节病的常见及较特征性的表现,CT能够比X线片更早且更详细显示。髋臼指标测量能够量化评估髋臼发育不良的程度。     

多层螺旋CT多平面重建及三维重建在复杂髋臼骨折中的临床价值

目的：探讨多层螺旋CT三维重建及多平面重建在复杂髋臼骨折中的临床价值。方法：回顾性分析36例复杂髋臼骨折的MPR、SSD、VR表现。结果：MPR、SSD、VR均显示了36例复杂髋臼骨折及16例股骨头脱位,MPR、SSD、VR还分别显示了骨盆其他骨骨折51、43、46处,MPR及VR显示了SSD没显示的髋关节内碎骨片1例。MPR在显示髋臼骨折线的方向、数量上较SSD、VR理想,SSD、VR图像立体感强,空间位置明确,对复杂髋臼骨折的分类及判断股骨头脱位的方向和距离较MPR好。结论：多层螺旋CT3D图像结合MPR及横断面图像,能立体直观地显示复杂髋臼骨折及关节脱位的空间位置,协助临床诊断和治疗。