髋臼后方包容角对髋臼后壁骨折稳定性评估的临床应用

目的探讨髋臼后方包容角值这一新指标对髋臼后壁骨折稳定性评估的临床应用。方法对34例单侧髋臼后壁骨折健侧的CT影像资料进行测量,估算出髋臼后壁完整和骨折20％、50％时髋臼后方包容角的大小,并利用该值对髋臼后壁骨折进行稳定性判定。通过组内相关系数（ICC）对髋臼后方包容角测量的稳定性进行评估,并将利用该方法进行髋臼后壁骨折稳定性判定的结果与传统Keith法进行比较。结果髋臼后壁完整和骨折20％、50％时髋臼后方包容角分别为（92．47±10．96）°、（74．30±9．5）°、（52．57±6．27）°不同测量者之间的ICC值为0．977～0．996,不同时间的ICC值为0．977～0．996,利用髋臼后方包容角法对髋臼后壁骨折稳定进行判定的结果与利用Keith法的结果之间的Kappa值为0．816。经髋臼后方稳定性试验判定,两者的准确率分别为84．2％和76．5％,差异无统计学意义（x^2=0．343,P=0．558〉0．05）。结论髋臼后方包容角测量时具有较高的稳定性,利用该方法对髋臼后壁骨折稳定性进行判定的结果与传统的Keith法一致性好,并且该方法简便、临床应用性强。     

髋臼后壁骨折三种内固定方式的生物力学研究及临床意义

背景：锁定重建接骨板已应用于髋臼后壁骨折的治疗,但关于其固定髋臼后壁骨折生物力学稳定性的研究报道甚少。目的：比较锁定重建接骨板、重建接骨板及单纯拉力螺钉固定髋臼后壁骨折的生物力学稳定性。 方法：取成人新鲜半骨盆标本18个,制成髋臼后壁骨折模型,随机分成三组。A组用2枚拉力螺钉固定,B组用重建接骨板固定,C组用锁定重建接骨板固定。进行轴向加载实验,测定各组骨折的纵向位移、内固定失效时的载荷及轴向刚度,以比较各内固定方式的稳定性。 结果：在相同载荷下,B组、C组骨折的纵向位移小于A组,B组、C组内固定失效时的载荷及轴向刚度大于A组,有统计学差异（P＜0.05）;B组与C组在纵向位移、内固定失效时的载荷及轴向刚度之间无统计学差异（P＞0.05）。 结论：锁定重建接骨板与重建接骨板的内固定稳定性优于单纯拉力螺钉内固定,锁定重建接骨板与重建接骨板内的固定稳定性相似,均可用于髋臼后壁骨折的内固定治疗。     

Surgical results and factors influencing outcome in patients with posterior wall acetabular fracture

The purpose of this study was to evaluate the results of open reduction and internal fixation in a large series of posterior wall fractures of the acetabulum and to identify the factors that affect the outcomes in this case series. One hundred twenty-one patients who had undergone open reduction and internal fixation of a fracture of the posterior wall of the acetabulum were assessed at a mean of 53 months (range, 24–163) after surgery. The functional outcome was evaluated with use of the modified Merle d'Aubigne scoring system, the Harris Hip Score (HHS), and the Short Form-36 Health Survey (SF-36) questionnaire. Final follow-up radiographs were graded according to Matta's radiologic criteria. Patient, fracture, and radiographic variables were analyzed to identify possible associations with functional and radiographic outcome. The quality of fracture reduction on postoperative radiographs was anatomical in 115 hips (95.0%), satisfactory in 6 cases (5.0%), and unsatisfactory in none. Final modified d'Aubignè scores were excellent in 45 hips (40.2%), good in 52 (46.4%), fair in 7 (6.3%), and poor in 8 (7.1%). Mean HHS was 91.5 ± 8.9 (48–100). The SF-36 scores were similar with respect to age and sex-matched norms, but physical domains in males remained lower in comparison with the normal population. The early reduction of an associated hip dislocation and quality of surgical reduction were strong positive predictors of functional and radiographic outcomes at follow-up, whereas associated injuries and the existence of pre-operative nerve palsy were negative predictors of patients' functionality. This study of surgically treated fractures of the posterior wall of the acetabulum has shown that functional and radiographic results are satisfactory in most patients, provided that prompt reduction of an associated hip dislocation and anatomical reduction of the fracture are carried out. Associated injuries and nerve lesions affect the final functional outcome.     

Reconstruction of Acetabular Posterior Wall Fractures

Background

The results after acetabular fracture are primarily related to the quality of the articular reduction. We evaluated the results of internal fixation of posterior wall fractures with using three-step reconstruction.

Methods

Thirty-three patients (mean age at the time of injury, 47.9 years; 28 males and 5 females) were followed for a minimum of 2 years after surgery. The three-step reconstruction included 1) preservation of soft tissues and reduction of the marginally impacted osteochondral (articular) fragments using screws, 2) filling the impacted cancellous void with a bone graft, and 3) reinforcement with buttress-plating. Clinical evaluation was done according to the criteria of D''aubigne and Postel, while the radiological criteria were those of Matta. The associated injuries and complications were evaluated.

Results

The clinical results were excellent in 15 (45.5%) patients and they were good in 5 (15.2%), (i.e., satisfactory in 60.7%), while the radiologic results were excellent in 10 (30.3%) and good in 14 (42.4%) (satisfactory in 72.7%). Heterotopic ossification was common, but this did not require excision, even without prophylactic treatment with indomethacin. Deep infection was the worst complication and this was accompanied by a poor outcome.

Conclusions

This study confirms that three-step reconstruction facilitates accurate and firm reduction of displaced posterior wall fractures of the acetabulum. Therefore, we anticipate less long-term arthrosis in the patients treated this way.     

髋臼三维记忆内固定系统治疗髋臼骨折

目的观察髂内动脉结扎、髋臼三维记忆内固定系统在复杂性髋臼骨折中的治疗效果。方法1997年8月至2005年9月,我们采用髋臼三维记忆内固定系统治疗31例复杂性髋臼骨折。结果31例患者得到随访,随访6~63个月,平均11个月。使用髋臼三维记忆内固定系统的复杂性髋臼骨折病例均固定于解剖位。异位骨化2例,1例外展受限。根据M od ified d′A ub ighe and Posta l临床分级标准,优良率96.77%。结论髂内动脉结扎、髋臼三维记忆内固定系统手术治疗复杂性髋臼骨折出血少,固定坚强,能早期活动,是髋臼解剖性重建的一种有效方法。     

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。     

Associated lesions in posterior wall acetabular fractures: not a valid predictor of failure

Background

The general outcome of posterior wall acetabular fractures is still the source of discussion. Posterior wall fractures are recognized throughout the literature as being difficult to treat. The aim of the present study was to analyze in our own patients the relevance of the classical prognostic criteria for the outcome of isolated posterior wall fractures and those with associated lesions.

Materials and methods

A prospective cohort of 33 consecutive patients treated operatively between 1996 and 2006 in a single level 1 trauma center for a posterior wall fracture of the acetabulum was analyzed retrospectively. Included were posterior wall acetabular fractures or associated posterior wall fractures, such as the combinations of posterior column with posterior wall, transverse with posterior wall, or T-shaped fracture with posterior wall fracture. Outcome measurement of the postoperative survival of the hip joints until the primary outcome reoperation (total hip replacement or fusion) and secondary outcome diagnosis of symptomatic osteoarthritis were performed.

Results

Twenty-six of the 33 patients with posterior wall fractures also had a dislocated joint. Twelve had isolated and 21 associated fractures. Six patients were reoperated with a THA (four patients within 2 years and one after 10 years), and one arthrodesis was done to treat a hematogenous septic arthritis in a degenerative hip joint. Secondary arthritis was observed in 10 patients.

Conclusions

No difference was found between the outcome in cases of isolated posterior wall acetabular fracture and the outcome in those with associated lesions. The classical prognostic criteria were not found to be relevant to the outcome for our group.     

Long term results after surgical management of posterior wall acetabular fractures

Background

Posterior wall fractures are the most common of all acetabular fractures, and there is universal consensus that displaced fractures are best treated with anatomical reduction and stable internal fixation. Though early and mid term results for such studies are available, few shed light on long term results. This study was performed to evaluate long term functional and radiological outcomes in patients with posterior wall acetabular fractures and to determine factors that may contribute adversely to a satisfactory final outcome.

Materials and methods

We retrospectively analysed the hospital records for patients who underwent open reduction and internal fixation (ORIF) for posterior wall acetabular fractures. Twenty-five patients (20 men, five women), including one with bilateral posterior wall fracture, with a mean age of 41.28 ± 7.16 years (range 25–60 years) and a mean follow-up of 12.92 ± 6.36 years (range 5–22 years) who met the inclusion criteria formed the study cohort. Matta’s criteria were used to grade postoperative reduction and final radiological outcome. Functional outcome at final follow-up was assessed according to d’Aubigné and Postel score.

Results

Anatomic reduction was achieved in 22 hips, imperfect in four and poor in none. Radiological outcome at final follow-up revealed excellent results in ten hips, good in eight, fair in five and poor in three. The final d’Aubigné and Postel scores were excellent in 14 hips, good in six and fair and poor in three each. Patients with anatomical reduction had a favourable functional and radiological long term outcome. However, the presence of associated injuries in lower limbs and a body mass index (BMI) >25 adversely affected the final functional outcome. Osteonecrosis was seen in three patients, heterotopic ossification in two and Morel Lavallee lesion in one. One patient had postoperative sciatic nerve palsy, which recovered 6 weeks after surgery.

Conclusion

Anatomic postoperative reduction leads to optimal functional and radiological outcome on long term follow-up; however, the presence of associated lower-limb injuries and BMI >25 adversely affects a satisfactory final outcome in patients with posterior wall acetabular fractures.

Level of evidence

(Level 4) Retrospective case series.     

双尖钢板技术治疗髋臼后壁骨折

目的 探讨双尖钢板在治疗髋臼后壁骨折中的应用价值.方法 回顾性分析2008年7月-2012年7月应用双尖钢板技术治疗的11例髋臼后壁骨折,其中男8例,女3例,年龄22 ～ 53岁,平均35.3岁,受伤至手术时间为1～19d,平均7.8d.所有患者均采取Kocher-langenbeck入路,取AO1/3管型钢板制成双尖钢板,结合重建钢板固定后壁骨折块.术后采用Matta复位标准评价骨折复位情况,采用改良Merled'Aubigne和Postel标准评定髋关节功能.结果 本组11例患者获得平均25个月(12 ～33个月)门诊或电话随访.末次随访时骨折复位质量:优7例,良3例,可1例,差0例,优良率90.9％;根据Merled'Aubigne和Postel评分标准评定患者疗效:优6例,良3例,可2例,差0例,优良率81.8％.其中术后1例患者发生异位骨化;无感染、无股骨头缺血性坏死、无创伤性关节炎等并发症的发生.结论 对于髋臼后壁存在无法用螺钉固定的骨折块或存在臼缘小型骨折块时,双尖钢板结合重建钢板可以提供坚强、牢靠的固定,术后患者功能恢复好,是一项有效的固定方式.     

3D打印多孔钛钢板一体化植入体修复髋臼后壁粉碎性骨折合并骨缺损的初步研究

目的 :探讨应用计算机辅助设计(computer aided design,CAD)结合3D打印技术对髋臼后壁粉碎性骨折合并骨软骨缺损进行修复重建的可行性,评估多孔钛合金支架钢板一体化植入体复合氮化钛生物陶瓷涂层的生物力学性能。方法:基于连续断层CT图像,利用CAD软件来构建具有特定三维内部结构的多孔钛钢板一体化植入体数字模型,以Ti6Al4V粉末为原材料打印出实体并于其关节面复合氮化钛涂层,观察植入体与髋臼匹配和贴附情况;利用Ansys软件进行有限元建模,分析正常组、传统组及植入体组髋臼在相同载荷状态下的应力分布、应力传导及形变位移等情况,验证植入体的生物力学性能。结果:植入体的多孔钛合金支架与髋臼匹配程度良好,钢板形态基本与骨表面贴附,根据Matta复位标准评定为优。有限元分析结果显示:植入体重建后髋臼在Von Mises应力峰值13.38 MPa接近正常组13.11 MPa,小于传统组15.66 MPa;植入体重建后的髋臼在应力分布和传导与正常组基本一致,稍优于传统组;植入体的最大相对位移为0.166 mm,处于可以接受的范围。结论:3D技术制备的多孔钛合金支架钢板一体化植入体复合氮化钛涂层具备优良的匹配度和生物力学性能;解剖重建使后壁头臼应力分布及传导恢复比较理想,接近正常的髋关节,其为临床治疗髋臼后壁粉碎性骨折合并严重骨缺损的病例提供新选择。     

重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折

目的探讨重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折的临床疗效及影响预后的相关因素。方法对35例髋关节后脱位伴髋臼后壁骨折的患者采用K-L入路、AO重建钢板内固定治疗。结果 35例均获随访,时间2年～5年4个月。采用改良Merle d’Aubingne-Postel评分系统评价:优16例,良12例,一般4例,差3例。Matta影像学分级:优13例,好16例,一般5例,差1例。临床结果与X线分级呈显著正相关。患者年龄≥55岁、复位时间≥12 h及复杂性骨折患者中临床评分明显降低。结论对于髋关节后脱位伴髋臼后壁骨折,及时确诊和满意复位、恢复髋臼的连续性和稳定性是取得满意手术疗效的关键;患者年龄、复位时间、骨折类型是影响患者预后的重要因素。     

髋臼骨折伴髋关节后脱位与坐骨神经损伤

目的 探讨髋臼骨折伴髋关节后脱位所致坐骨神经损伤的临床特点及影响预后的因素。方法 共 14例患者, 3例非手术治疗,患肢持续股骨髁上牵引术; 11例手术治疗,髋臼骨折复位内固定、坐骨神经探查松解术。结果 14例患者随访 0.5～ 3.5年,平均 18个月。根据 Matta标准,髋臼骨折治疗后解剖复位为 8例 (57.1％ ),满意复位为 6例 (42.9％ );根据英国医学研究院神经外科学会制定的 MCRR标准,坐骨神经损伤恢复的优良率为 57.1％。结论 髋臼骨折伴髋关节后脱位易造成坐骨神经损伤;坐骨神经的腓总神经分支较胫神经易受损,且预后不佳;髋臼骨折手术中屈膝伸髋位可减少医原性坐骨神经损伤的发生;伤后早期行髋臼骨折复位内固定术、坐骨神经探查松解术,将有利于坐骨神经损伤的恢复。     

Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement

PurposeTo evaluate the quality of reduction, clinical outcomes and complications of associated both column acetabular fractures with posterior wall involvement that are treated through single ilioinguinal approach and fixation of posterior wall by lag screws only.MethodsWe conducted a retrospective review involving ninety-nine consecutive patients with associated both column fractures of acetabulum treated through single ilioinguinal approach. Patients were divided into two groups. The first group consisted of 35 patients presented with both column fractures with posterior wall involvement that fixation performed with lag screws. This group was compared to a second group of 64 patients with both column fractures without posterior wall involvement. The quality of reduction was assessed using criteria described by Matta. The size of posterior wall fragment was measured. Functional outcome was evaluated using Modified Postel Merle D’Aubigne score. Radiographs at the latest follow up were analyzed for arthritis (Kellgren-Lawrence classification), and femoral head avascular necrosis (Ficat/Arlet classification).ResultsThe study showed no significant differences in all preoperative variables (P > 0.05). While intraoperative blood loss and operative time in group 1 were increased compared to group 2, the difference was not statistically significant (P > 0.05). The height, relative depth and peripheral length of posterior wall respectively were 27.8 ± 2.5 mm (range: 24–35 mm), 71.5 ± 5.4% (range: 65–88%), 23.0 ± 2.3 mm (range: 17–28 mm). The mean posterior wall fracture displacement is 5.0 ± 3.2 mm (range: 0–11 mm). There was no difference regarding the quality of reduction between the two groups (P > 0.05). The excellent to good clinical outcome was around 71.4% in the group 1 versus 73.4% in the group 2 at the final follow-up, this difference was not statistically significant (P > 0.05). There was no difference in rate of complications between the two groups (P > 0.05).ConclusionsLag screws fixation of posterior wall through single ilioinguinal approach in associated both column fractures of acetabulum is a safe and effective method. Our results shown that the presence of posterior wall fracture in cases of associated both column fractures does not compromise the clinical outcomes.     

髋臼后壁骨折的手术治疗

目的探讨手术治疗髋臼后壁骨折的临床疗效。方法从2001年1月．2003年6月，手术治疗有明显移位的髋臼后壁骨折89例，男67例，女22例，平均年龄34．2岁。伴有股骨头脱位62例；按Letournel分类，典型后壁骨折47例，后上骨折33例，后下骨折9例；原发性坐骨神经损伤5例。受伤至手术时间：1—93d，平均11．2d。手术全部采用Kocher—Langenbeck入路。结果平均手术时间87min，失血247mL。全部采用钢板加螺钉固定，手术一过性坐骨神经麻痹4例。平均随访55．6个月（37—66个月），按Matta的复位标准、x线评估标准和Matta改良的d’Aubigne和Postel临床标准进行评估。全部患者均达到解剖复位，x线评估结果：优71例，良16例，一般2例；临床评估结果：优67例，良14例，一般8例。2例坐骨神经高位分支、腓总神经支完全断裂虽经神经吻合，仍有拖行步态，另3例除腓骨长短肌力4级外，步态正常；无感染和股骨头坏死病例，异位骨化11例。结论髋臼后壁骨折行手术治疗可获得良好的临床疗效；合并股骨头脱位急诊复位后的后壁骨折并不增加股骨头坏死率；术前坐骨神经断裂与后壁有大骨折块及伴有坐骨神经盆内高位分支有关。     

术前虚拟规划联合3D打印模板预塑形钢板治疗髋臼后壁骨折

目的:评估虚拟术前规划和3D打印模板预塑形钢板治疗髋臼后壁骨折的可行性和准确性。方法:回顾性分析2017年8月至2020年8月治疗的髋臼后壁骨折患者29例,根据是否采用术前虚拟规划和3D打印模板分为2组,3D打印组14例,男10例,女4例;年龄21～53岁;基于患者骨盆CT数据采用Mimics和3-Matic软件进行虚拟手术规划,虚拟复位骨折,设计后壁钢板模板及螺钉固定位置,模拟透视记录合适方位以指导术中透视,打印后壁钢板模板和带有后壁骨折块的钢板螺钉模型,然后根据模板预塑形钢板备用。常规组15例,男10例,女5例;年龄19～55岁;采用常规的方法术中折弯钢板适应骨折区域。比较两组术中出血量、手术时间、骨折复位质量和髋关节功能。结果:23例患者获得随访,时间12～30个月。两组患者骨折均愈合,愈合时间3～6个月。两组手术时间、术中出血量比较,差异均有统计学意义(P<0.05)。末次随访时髋关节功能Merle d’Aubign-Postel评分,3D打印组疼痛程度评分低于常规组(P<0.05);两组行走能力、髋关节活动度和总分比较,差异均无统计学意义(P>0.05)。3...     

髋臼镍钛记忆合金三维内固定系统治疗陈旧性髋臼后壁骨折合并骨缺损

目的探讨应用髋臼镍钛记忆合金三维内固定系统(acetabular tridimensional memory alloy-fixationsystem,ATMFS)结合自体髂骨解剖重建髋臼后壁骨折合并骨缺损的临床效果。方法 2002年1月-2009年2月,收治17例陈旧性髋臼后壁骨折合并骨缺损患者。男11例,女6例;年龄20～60岁,平均41.7岁。骨折至该次入院时间为14～180 d,平均63 d。髋臼关节面移位均≥3 mm。骨缺损按照美国骨科医师协会(AAOS)髋臼骨折缺损分型标准:Ⅰ型4例,Ⅱ型6例,Ⅲ型5例,Ⅳ型2例。手术去除残留的髋臼后壁骨折块和增生软组织,复位股骨头后取自体游离髂骨植于后壁缺损处,ATMFS固定重建髋臼后壁,加用人工韧带重建髋关节囊韧带,防止股骨头再脱位。结果术后3 d骨折复位按照Matta影像评定标准:优8例,良6例,可2例,差1例,优良率为82.3%。术后切口均Ⅰ期愈合,无坐骨神经损伤发生。患者术后均获随访,随访时间1～8年,平均3.9年。术后2～6个月骨折均愈合,平均3.6个月。术后1例发生股骨头缺血性坏死,1例发生髋臼周围异位骨化。术后1年,患者髋关节功能按照Merle d’Aubigné-Postel的评分系统评价:获优9例,良6例,可1例,差1例,优良率为88.2%。结论 ATMFS结合自体髂骨游离移植,利用人工韧带重建髋关节囊韧带,是治疗髋臼后壁陈旧性骨折合并骨缺损的有效方法,它可以恢复髋关节的后方稳定,防止股骨头再脱位。     

髋臼后柱骨折与后柱伴后壁骨折的诊断和治疗

目的探讨髋臼后柱骨折、后柱伴后壁骨折的诊断和治疗方法。方法15例A2型髋臼骨折均采用手术治疗。手术入路：Kocher-Langenbeck入路6例，改良Kocher-Langenbeck入路9例。结果15例中达到解剖复位13例，复位欠佳2例。获得随访11例，随访时间1～4年，平均2年。关节功能按改良d-Aubigne和Postel功能评定标准，优良10例，可1例。术后异位骨化Brookel Ⅰ度1例、Ⅱ度2例。原发坐骨神经损伤2例，1例在1年后恢复，另1例未恢复。结论只有把患髋前后位片、闭孔斜位片、髂骨斜位片、CT平扫图像、SSD重建图像、MPR图像和VRT重建图像结合起来，才能做出髋臼后柱骨折或后柱伴后壁骨折的诊断。绝大多数髋臼后柱骨折和后柱伴后壁骨折需行玎放复位内固定，复位后柱骨折的最好方法是联合使用Schanz螺钉与Farabeuf钳，术中根据具体情况选择1块或2块后柱重建钢板固定。     

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。     

弹性钢板在粉碎性髋臼后壁骨折治疗中的应用

目的 探讨弹性钢板在粉碎性髋臼后壁骨折治疗中的应用价值. 方法 回顾性分析2002年2月至2010年2月采用手术治疗的31例粉碎性髋臼后壁骨折患者资料,男22例,女9例;年龄20～55岁,平均31.5岁.受伤至手术时间为1～17d,平均6.7d.手术均采用Kocher-Langenbeck入路,术中尽量保护粉碎骨块上附着的软组织,后壁有压缩者取大转子松质骨填充,尽量使每一粉碎骨折块都达到解剖复位,将1/3管型钢板制成弹性钢板固定,再予重建钢板呈“十”、“廾”或“卅”字形固定.采用改良的Merled 'Aubigné和Postel评分系统评定患髋功能. 结果 31例患者术后骨折复位质量根据改良的Matta复位标准评定:优24例,良5例,可1例,差1例,优良率为93.5％.23例患者术后获平均2.6年(2～8年)随访.术后1年根据改良的Merle d'Aubigné和Postel评分系统评定患髋功能:优15例,良4例,中3例,差1例,优良率为82.6％.1例患者发生股骨头坏死.4例患者发生异位骨化,其中1例为Brooker分级Ⅲ级,1例为Ⅱ级,2例为Ⅰ级.2例坐骨神经损伤患者术后3个月恢复.4例患者术后3年发生创伤性关节炎. 结论 对于粉碎性髋臼后壁骨折,弹性钢板能提供稳定可靠的固定,且能满足早期功能锻炼的要求,具有一定的应用价值.     

股骨大转子截骨联合Kocher-Langenbeck入路治疗髋臼高位后壁骨折

目的：评价股骨大转子截骨技术联合 Kocher-Langenbeck 入路治疗髋臼高位后壁骨折的临床疗效。方法：回顾分析 2020 年 1 月至 2022 年 12 月收治的髋臼高位后壁骨折患者 20 例,其中男 12 例,女 8 例;年龄 18~75 岁。根据手术方式的不同分为两组,10 例采用股骨大转子截骨联合 Kocher-Langenbeck 入路为观察组,男 5 例,女 5 例,年龄 18~75 岁;10 例单纯 Kocher-Langenbeck 入路为对照组,男 7 例,女 3 例,年龄 18~71 岁。使用 Matta 复位标准评价两组骨折的复位质量,末次随访时采用 Harris 评分比较两组患者髋关节功能。分析两组患者手术时间、失血量、术后并发症情况。结果：两组患者均获得随访,时间 10~24 个月。根据 Matta 骨折复位质量评价标准,观察组获解剖复位 6 例,满意复位 3 例,不满意复位 1 例;而对照组仅 3 例获解剖复位,满意复位 3 例,不满意复位 4 例。末次随访时,观察组髋关节 Harris 评分为 71.4~96.6 分,对照组为 65.3~94.5 分。根据 Harris 评分结果,观察组髋关节功能优 6 例,良 3 例,可1 例;对照组,优 2 例,良 3 例,可 3 例,差 2 例。观察组术中出血量 300~700 ml,手术时间 120~180 min;对照组术中出血量 300~650 ml,手术时间 100~180 min。观察组创伤性关节炎 1 例,异位骨化 1 例;对照组创伤性关节炎 3 例,异位骨化 3 例,髋外展无力 1 例。结论：通过对结果数据的分析,与单纯采用 Kocher-Langenbeck 入路相比,将股骨大转子截骨技术用于高位后壁骨折的治疗,能够有效提高骨折解剖复位率,提升髋关节功能优良率,同时降低手术并发症的发生,值得临床应用。但因样本量较少,未进行相关统计学分析,结论仍需要进一步的临床验证。