前后联合入路内固定治疗髋臼横断伴后壁骨折及股骨头后脱位

目的探讨前后联合入路骨盆重建钛板内固定治疗髋臼横断伴后壁骨折及股骨头后脱位的可行性与临床效果。方法对22例髋臼横断伴后壁骨折及股骨头后脱位采用Kocher-Langenbeck和髂腹股沟联合入路,应用专用骨盆髋臼复位器械行骨盆重建钛板和螺钉内固定治疗。结果骨折复位质量按照Matta标准评价:解剖复位18例,满意复位4例。术后随访12～38个月(平均25个月),采用Modified d'Aubigne and Postel功能评定标准判定:优17例,良4例,可1例,优良率95.6%。结论选择髋臼横断伴后壁骨折及股骨头后脱位中前方骨折线高且移位大者采用前后联合入路行内固定治疗,可使髋臼骨折达到最大限度的复位并获得理想的髋关节功能康复。     

髋臼骨折合并同侧股骨颈骨折的手术治疗

目的：探讨髋臼骨折合并同侧股骨颈骨折的治疗方法及其疗效。方法2005年1月至2010年1月,本院收治5例髋日骨折合并同侧股骨颈骨折患者,4例男性,1例女性,平均年龄38岁。所有患者均先试闭合复位内固定股骨颈,闭合复位失败再根据髋臼骨折类型采用前路或后路或联合人路先复位固定股骨颈骨折再复位固定髋臼骨折。术后按照Matta标准和Haidukewych标准分别评价髋臼复位和股骨颈复位。结果术后随访18．74个月,平均35个月。髋臼骨折4例解剖复位,1例满意复位;股骨颈骨折均复位优,所有患者均骨折愈合。2例患者伴脱位,进行延期切开复位内固定,术后患者出现股骨头坏死,行全髋置换,术后患者对功能满意,余3例患者未出现股骨头坏死,对术后功能满意。结论髋臼骨折合并同侧股骨颈骨折采用切开复位内固定可以恢复髋关节良好功能,髋臼的解剖复位对术后髋关节功能起很大作用。     

髋臼后壁粉碎性骨折伴髋关节脱位的手术治疗

目的探讨髋臼后壁粉碎性骨折伴髋关节脱位的手术治疗效果。方法对16例髋臼后壁粉碎性骨折伴髋关节脱位患者行Kocher Langenbeck入路切开复位内固定治疗。结果随访15例,1例失访,随访时间6个月～5年。根据改良的d′Aubingne和Postel的髋臼骨折临床结果评分标准,优6例,良7例,可2例。结论对各种类型的髋臼后壁粉碎性骨折伴髋关节脱位患者进行切开复位内固定治疗,临床效果满意。     

髋臼合并同侧股骨颈骨折的手术治疗与预后

目的 探讨髋臼合并同侧股骨颈骨折的手术方法与预后.方法 1990年10月至2008年1月共收治7例髋臼合并同侧股骨颈骨折患者,其中男5例,女2例;年龄22～55岁(平均38.6岁).髋臼骨折按Letournel分类:后壁骨折2例,后柱伴后壁骨折1例,横行伴后壁骨折2例,双柱骨折2例.股骨颈骨折按Garden分型:Ⅲ型2例,Ⅳ型5例.其中X线片和CT片示股骨颈骨折合并股骨头游离脱位于髋臼后上方者5例,仅显示股骨颈骨折而无脱位者2例.结果切开复位内固定术后X线片示5例移位髋臼骨折患者获解剖复位,2例获满意复位.股骨颈骨折均获满意复位和固定.7例患者术后获1～18年(平均8.6年)随访,X线片示5例合并股骨头脱位者日后均出现股骨头缺血性坏死,坏死率高达100%(5/5),髋关节功能恢复均为差,于内固定术后2～4年改行全髋关节置换术.而2例股骨头未脱位者至今X线片上仍未显示任何股骨头坏死迹象,也无创伤后关节炎表现,髋关节功能恢复均为优.结论 髋臼合并同侧股骨颈骨折患者,如同时合并股骨头脱位,因股骨头坏死率高,应首选全髋关节置换术治疗.如未合并股骨头脱位,可以考虑首选切开复位内固定.     

髓臼骨折伴髓关节后脱位及交锁的诊断与治疗

目的 研究改良联合前后双入路手术治疗，髋臼横断型骨折的术式。方法 对三例髋臼横断伴髋关节后脱位闭合复位失败者，应用联合前后双入路切口，复还由骨折区向后滑脱的髂腰肌，解除关节交锁复位破关节，髋臼前柱用四孔钢板固定，后柱用螺钉 钢丝固定。结果 手术复位满意，达到解剖复位，固定稳定，可早期功能锻炼。结论 对此类特殊类型的髋臼骨折应在全身情况允许时，尽早手术治疗，尽可能达到解剖复位并给予坚强固定。     

可吸收螺钉治疗股骨头骨折伴髋关节后脱位

目的探讨应用可吸收螺钉治疗股骨头骨折伴髋关节后脱位的效果。方法髋后外侧入路手术治疗26例股骨头骨折伴髋关节后脱位患者,股骨头骨折均采用可吸收螺钉固定;Ⅲ型合并股骨颈骨折者采用钛质空心螺钉固定,Ⅳ型合并髋臼骨折者采用髋臼三维记忆内固定系统固定髋臼骨折。结果26例均获随访,时间15～48个月。按D′Aubigue-Postel评分法：优10例,良13例,中1例,差2例（1例股骨头缺血性坏死,1例股骨头缺血性坏死合并髋周异位骨化）。未出现可吸收螺钉断裂及异物反应现象,无深部感染及创伤性关节炎等并发症发生。结论股骨头骨折伴髋关节后脱位采用髋后外侧入路、可吸收螺钉及髋臼三维记忆内固定可获得理想的治疗效果。     

复杂髋臼骨折的手术治疗

目的：回顾分析复杂髋臼骨折的临床特点及治疗方法。方法：44例髋臼骨折患者，根据不同骨折类型选择不同手术入路，行开放复位内固定手术。结果：37例获得平均4．5年随访，移位的髋臼骨折复位后与股骨头对应关系满意，骨折平均愈合时间10—12周，优良率达81％。结论：复杂的髋臼损伤具有分类上的多样性和复杂性，治疗上应积极开放复位内固定，以获得一个稳定、无痛、活动和负重良好的髋关节。     

手术治疗髋臼横形骨折伴后壁骨折

目的 介绍应用前后入路治疗髋臼横行骨折伴后壁骨折的手术经验。方法 回顾分析1999-2006年收治的资料完整的手术治疗髋臼横形骨折伴髋臼后壁骨折或股骨头脱位患者11例，按照Letournel-Judet骨折分型为复杂骨折中髋臼横形骨折伴髋臼后壁骨折，按AO分型为B1-2型。骨折采用重建钢板及螺钉固定。结果 全部患者均得以随访，平均随访3年。复位情况按Judet等方法进行评估，解剖复位6例，满意复位4例，不满意1例。髋关节功能按美国矫形外科研究院髋关节功能的方法进行评估，优6例，良可4例，差1例。结论 手术是髋臼横形骨折伴髋臼后壁骨折治疗的有效方法，前后入路、复位质鼍、牢固固定是治疗关键。     

复杂髋臼骨折并髋关节脱位的手术治疗

目的 探讨复杂髋臼骨折并髋关节脱位的手术治疗方法、并发症的防治及功能康复.方法 对21例复杂髋臼骨折并髋关节脱位进行骨折复位及内固定治疗,观察骨折复位情况、髋关节功能及并发症等.结果 按照美国矫形外科研究院的髋关节评定标准:优8例,良5例,可5例,差3例,优良率61.9%.结论 复杂髋臼骨折并髋关节脱位需尽早手术治疗,选择合适的手术人路、骨折解剖复位、积极预防并发症、适时康复锻炼可获得相对满意的疗效.     

髋臼骨折合并股骨头骨折的治疗及预后分析

[目的]探讨髋臼骨折合并股骨头骨折的治疗方法及预后。[方法]2003年11月～2008年3月,共收治12例髋臼骨折合并股骨头骨折病例,行髋关节脱位闭合复位、骨牵引,10例行髋臼骨折切开复位重建钢板固定、股骨头骨折空心螺钉或可吸收螺钉固定,1例行髋臼后壁骨折复位重建钢板固定+全髋关节置换术,1例保守治疗。[结果]经2～7年的随访(平均4.5年),根据Thompson-Epstein的临床和影像学评定标准,疗效优2例,良5例,可2例,差3例,优良率58.3%。[结论]根据类型采用相应的手术治疗方法,早期治疗及功能锻炼,较晚负重,可取得较为满意的临床疗效。     

EPSTR技术在髋臼后壁骨折固定中的应用

目的报告EPSTR技术在髋臼后壁骨折固定中的临床应用结果。方法自2006年1月至2011年1月,对46例髋臼后壁骨折患者行内固定后应用EPSTR技术修复髋关节后侧软组织,其中男36例,女10例;年龄25~55岁,平均42.5岁,伤后手术时间2~7 d,平均5 d。髋关节后侧软组织采用"T"形切开,行髋臼内固定后,关节囊和外旋短肌作为一层再次附着到大粗隆。结果术后随访2.5~6.0年,平均4.5年。随访期间没有发生髋关节脱位和股骨头缺血性坏死,有2例发生骨关节炎,没有出现与本项技术相关的并发症。按Harris评定标准进行疗效评定,优良率为93.5%,取得了满意的效果。结论髋臼后壁骨折固定后采用EPSTR技术,有利于术后功能恢复和加强髋关节稳定性。     

Anterior Dislocation of the Hip Associated with an Actebular Fracture: Case Report

Abstract Anterior hip joint dislocation is less common than posterior dislocation. Although fractures of the acetabulum can occur in anterior hip dislocations, they are infrequently. In this article, we report an uncommon lesion in a woman who sustained an anterior dislocation of the hip associated with a fracture of the acetabular wall. Close reduction was performed immediately the initial injury. The patient underwent open reduction and internal fixation since the hip joint was result unstable and the CT scan showed the presence of a bone fragment of the anterior acetabular wall. At 2-year follow-up, the clinical and radiological results are excellent.     

髋臼后壁边缘压缩骨折伴髋关节后脱位的诊治

目的探讨髋臼后壁边缘压缩骨折伴髋关节后脱位的诊断与治疗。方法2000年2月- 2005年10月,对11例涉及髋臼后壁边缘压缩骨折伴髋关节后脱位患者进行回顾性总结,所有患者的后壁边缘压缩骨折、髋关节后脱位均由CT扫描得到证实。患者均采用手术切开复位,对边缘压缩骨折进行撬起和植骨,重建钢板螺丝钉内固定术。结果所有患者获得平均5-56个月(32．4个月)随访,临床结果采用改良d'Aubigne和Postel髋关节评分标准:优4例,良4例,可2例,差1例,优良率为72．7％。1例原发坐骨神经损伤,系骨折块压挫伤,于术后2个月完全恢复。1例因术中未严格保持伸髋屈膝位导致坐骨神经牵拉伤,4个月后基本恢复。1例异位骨化,为BookerⅡ型。1例复位欠佳者出现创伤性关节炎,关节间隙变窄。结论髋臼后壁边缘骨折伴髋关节后脱位患者容易发生边缘压缩性骨折,术前CT扫描可明确诊断,术中要对边缘压缩骨折部分撬起和充分植骨,提高股骨头与髋臼解剖对应率,可取得较好疗效。     

Displaced acetabular fractures in the elderly: Results after open reduction and internal fixation

BackgroundThe optimal management of elderly patients with displaced acetabular fractures remains controversial. This paper aims to summarize the clinical results of open reduction and internal fixation (ORIF) and the possible factors influencing them.MethodsRadiographic and clinical data on 52 elderly patients with displaced acetabular fractures that were treated by ORIF between May 2000 and May 2008 were retrospectively analysed. Data, such as fracture type (Letournel's classification system), quality of reduction, clinical outcomes (Harris hip score and modified Merle d’Aubigne-Postel score), and radiological outcomes (Matta score), were evaluated.ResultsGood to excellent clinical and radiological outcomes were recorded in 43 (82.7%) and 37 patients (71.2%), respectively. Acetabular fractures without radiographic features, such as quadrilateral plate fracture, Gull sign, posterior dislocation of hip, posterior wall marginal impaction, comminuted posterior wall fracture, and femoral head injury, can still achieve good to excellent outcomes. However, patients with the abovementioned radiographic features tend to achieve fair or poor outcomes. When an acetabular fracture with the aforementioned features, except for femoral head injury, can achieve and maintain anatomic reduction until complete fracture healing, the difference between fractures with and without the radiographic features is no longer significant. The results indicate that the outcomes are more affected by reduction rather than radiographic features.ConclusionORIF may be suggested for displaced acetabular fractures in the elderly. Good to excellent outcomes and a high degree of patient satisfaction can be achieved in majority of the patients. We recommend ORIF as the preferred treatment for displaced acetabular fractures without the abovementioned radiographic features.Level of evidenceTherapeutic level IV.     

Results of operative treatment of fractures of the posterior wall of the acetabulum

BACKGROUND: The purpose of this study was to determine the clinical outcome in patients in whom a displaced fracture of the posterior wall of the acetabulum had been treated by open reduction and internal fixation. METHODS: One hundred patients who had had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum were studied. Ninety-four patients were assessed at a mean of five years (range, two to fourteen years) after the injury. Six patients with a poor result were followed for less than two years. The functional outcome was evaluated with use of the clinical grading system adopted by Letournel and Judet with incorporation of modifications by Matta. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional outcome. RESULTS: The reduction of the fracture, as determined with plain radiography, was graded as anatomic in ninety-seven patients and as imperfect in three. The clinical outcome at the time of final follow-up was graded as excellent in fifty-five patients, very good in twenty-five, good in nine, fair in one, and poor in ten. The radiographic result was excellent in eighty-one patients, good in five, fair in four, and poor in ten. There was a strong association between the clinical outcome and the final radiographic grade. Variables identified as risk factors for an unsatisfactory clinical result included a delay of greater than twelve hours before reduction of an associated hip dislocation, an age of fifty-five years or older at the time of injury, intra-articular comminution, and osteonecrosis. CONCLUSIONS: The uncomplicated radiographic appearance and relatively simple operative approach for fractures of the posterior acetabular wall belie the risk of poor results. Prompt reduction of an associated hip dislocation is imperative. Fractures in elderly patients and those with extensive comminution are more likely to have a poor clinical result. However, a high likelihood of a long-term good-to-excellent result can be expected following anatomic reduction and internal fixation of these fractures.     

髋臼后壁骨折并髋关节脱位手术治疗的疗效分析

目的探讨髋臼后壁骨折合并股骨头后脱位的手术治疗方法及影响预后的因素。方法本组25例患者，伤后均急诊行手法复位．多数在伤后5～7天应用Kocher—langenback切口行手术治疗，髋臼后壁骨折复位后，应用螺丝钉或加钢板内固定，必要时植骨。结果全部患者均随诊6～36个月．根据相关资料评定：X线评定结果优19例、良4例、可2例，优良率：92％。临床功能评定优13例、良8例、可3例，差1例，优良率：84％。结论髋臼后壁骨折并关节脱位解剖复位及手术内固定可提高此类损伤疗效和减少并发症发生。     

Acetabular depression fracture accompanying posterior fracture dislocation of the hip

The acetabular depression fracture is defined as a rotated, impacted, osteocartilaginous fragment of the posteromedial acetabulum that occurs in conjunction with a posterior fracture dislocation of the hip. Displacement of this fracture fragment creates incongruity of the posterior acetabular articular surface and the potential for hip joint instability. A retrospective review of hip dislocations over a 3-year period disclosed 75 posterior fracture dislocations of the hip. A total of 71 hips had computerized tomography (CT) scanning after successful closed reduction of the dislocation. Of the 75 dislocations, 58 were treated with open reduction and internal fixation for reproducible posterior subluxation or redislocation upon clinical examination, non-concentric closed reduction, and/or unacceptable articular fracture displacement. The acetabular depression fracture was identified in 17 cases (23%). A total of 16 were found on preoperative CT scans, and one was discovered at the time of open reduction. Preoperatively, each of these injuries demonstrated posterior instability with hip flexion less than 90 degrees. Treatment consisted of disimpaction of the fragment with elevation to the level of the concentrically reduced femoral head. The fragment was stabilized with packed cancellous bone graft obtained from the greater trochanter. The separate posterior lip fragment was then reduced and internally stabilized to ensure reduction of the acetabular depression fragment. We conclude that this variant of the posterior fracture dislocation of the hip occurs in a significant percentage of these injuries. Preoperative recognition of this fracture may correlate with posterior hip instability, and its presence may be an indication for open reduction and internal fixation of the fracture. Long-term studies of this lesion are still needed.     

影响髋臼后壁骨折手术疗效的分析

目的 分析影响手术治疗髋臼后壁骨折疗效的因素并总结治疗经验. 方法 1993年8月至2006年8月手术治疗且符合纳入标准髋臼后壁骨折患者105例,用改良的Merle d'Aubigné和Postel评分系统评价临床效果,用Matta放射学标准评价影像学结果.通过统计分析说明年龄、性别、受伤至手术时间、合并伤、髋关节脱位情况、是否存在边缘压缩、骨折复位质量、有无合并股骨头骨折,异位骨化程度和有无股骨头坏死等与临床效果间的关系. 结果所有患者平均随访4.1年(2.0～10.6年).临床效果:优32例,良56例,可11例,差6例,优良率83.8%(88/105).影像学结果:优52例,良36例,可12例,差5例,优良率83.8%(88/105).患者年龄、性别、受伤至手术时间、合并伤及髋关节脱位与临床效果无显著相关.存在边缘压缩、合并股骨头骨折、骨折复位差、严重异位骨化和股骨头坏死与临床效果显著相关.临床效果与影像学结果存在强相关性(Kappa=0.772). 结论术中仔细探查、解剖复位、牢靠固定是关键.存在边缘压缩骨折、骨折复位差、合并股骨头骨折、严重异位骨化和股骨头坏死是影响治疗效果的主要因素.     

手术治疗髋臼后壁骨折伴股骨头脱位

目的探讨手术治疗髋臼后壁骨折伴股骨头脱位的临床疗效。方法18例髋臼后壁骨折伴股骨头脱位患者全部采用K-L入路复位钢板螺丝钉内固定治疗。结果手术时间60～120（90±30）min,失血量200～480（340±140）ml,18例均获随访,时间18～53（35.5±17.5）个月。采用Matta改良的d′Anbigne和Postel临床评价标准：优12例,良3例,可3例。结论髋臼后壁骨折伴股骨头脱位手术治疗可获得良好的临床效果,股骨头脱位复位越早越好,对伴有广泛粉碎性骨折者出现较差结果可能性更大。