手术治疗髋臼后壁骨折45例

目的：探讨应用重建钢板内固定治疗髋臼后壁骨折的临床疗效。方法：对45例经手术复位重建钢板内固定治疗的髋臼后壁骨折进行回顾性分析,男31例,女14例;年龄19～68岁,平均37.6岁。合并髋关节脱位者41例。全部后侧Kocher-Langenbeck切口。结果：45例均获随访,随访时间为12～48个月,平均26个月。按Matta的X线复位标准和Matta改良的d＇Aubigne临床标准评估,解剖复位38例,满意复位7例;临床结果优30例,良10例,一般5例,优良率为88.9%。本组中发生创伤性关节炎4例,股骨头坏死2例,异位骨化2例,下肢深静脉血栓1例,无切口感染和骨不愈合。结论：重建钢板内固定治疗髋臼后壁骨折可获得满意的临床疗效。骨折复位质量、伤后至手术时间、骨折粉碎程度、手术经验是影响髋臼后壁骨折治疗效果的关键。     

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。     

髋臼横形伴后壁骨折的手术治疗

目的探讨髋臼横形伴后壁骨折手术治疗方法、技巧及临床效果。方法本组9例髋臼横形伴后壁骨折患者，男8例，女1例，年龄21～63岁，平均32．4岁，术前常规摄髋关节前后位、髂骨斜位、闭孔斜位片，CT平扫和三维重建，并在髋臼模型上标出骨折线的走向。采用Kocher—Lan—genbeck切口显露后柱及后壁，先复位横形骨折部份，用螺丝钉和钢丝固定，再复位后壁骨折块，用重建钢板固定。术后功能锻炼。结果本组9例均获得随访，随访时间4～48个月，平均25月。按Matta标准，在3个Judt位x线上骨折解剖复位者7例，满意复位者2例，不满意复位者0例。术后疗效评价按美国矫形外科学会制定的标准，本组优5例，良3例，可1例。结论采用螺丝钉纲丝维持和稳定已复位的横形骨折块位置，以便用重建钢板固定，手术操作简便，疗效满意。术前好的影像学资料和充分的准备对手术顺利进行非常重要。     

髋关节中心性骨折脱位的外科治疗

目的探讨髋关节中心性骨折脱位的诊断、分类及外科治疗的特点。方法采用回顾性研究方法对髋关节中心性骨折脱位的外科治疗病例进行总结分析。结果 8例髋关节中心性骨折脱位均为臼底部骨折并股骨头中心型脱位突入盆腔,其中仅累及臼底部骨折3例,臼底部骨折合并髋臼前柱骨折2例,臼底部骨折合并髋臼前柱骨折及前壁骨折3例。8例均采用术前下肢股骨牵引使脱位的股骨头复位及改良扩大的髂股入路进行髋臼底骨折的切开复位钢板螺丝钉内固定术,其中2例臼底破损严重的病例采用取带缝匠肌髂骨骨瓣植骨重建术。髋臼骨折复位按Matta标准,术后解剖复位4例,满意复位4例,无不满意复位。结论髋关节中心性骨折脱位为髋臼较少见的严重损伤。对中心性脱位的股骨头宜采用三向分力的股骨牵引进行复位,因髋臼底位置深在手术复位较困难,故采取髂股手术入路,直视下可显露髋臼底骨折处。采用重建钢板进行骨折固定可确保髋臼内壁的光滑,髋臼底破损严重病例采用带肌蒂髂骨骨瓣植骨可起到重建臼底及加速骨折愈合的目的 。     

经顶型移位髋臼横形骨折手术疗效分析

目的 探讨手术治疗经顶型移位髋臼横形骨折的疗效及其影响因素.方法 1990年5月至2006年7月,手术治疗经顶型移位髋臼横形骨折37例,男26例,女11例;年龄22～64岁,平均34岁.根据复位质量、臼顶骨折粉碎程度、髋关节稳定性、股骨头软骨损伤等因素进行分组,按Matta术后X线复位标准和放射学评估标准及改良的Merle d'Aubigne和Postel功能评分标准进行评估.结果 所有患者均获随访,随访时间16～121个月,平均88.6个月.术后解剖复位31例,复位欠佳4例,复位差2例.2例患者术后X线片示髋关节不稳.根据改良的Merle d'Aubigne和Postel功能评分,临床疗效:优16例(43.24%),良14例(37.84%),可4例(10.81%),差3例(8.11%),优良率为81.08%;远期随访MattaX线疗效:优14例(37.84%),良15例(40.54%),可4例(10.81%),差4(10.81%),优良率为78.38%.临床疗效与X线疗效存在相关性.临床优良率在解剖复位和非解剖复位组分别为90.32%和33.33%,在臼顶粉碎性骨折和非粉碎性骨折组分别为58.33%和92.00%,在髋关节不稳组和稳定组分别为0和85.71%,在股骨头软骨损伤和无软骨损伤组分别为42.86%和90.00%.结论 骨折复位不佳、臼顶粉碎性旨折、髋关节不稳及股骨头软骨损伤等因素可直接影响经顶型移位髋臼横形骨折的手术疗效.     

累及臼顶的髋臼后壁骨折治疗进展

臼顶是髋臼主要负重区,其解剖位置深,生物力学特性复杂。累及臼顶的髋臼后壁骨折,存在术中视野暴露困难及术后创伤性关节炎等并发症发生率高的问题。臼顶的完整性和稳定性与髋臼的生理功能紧密相关,因此臼顶的解剖复位及坚强内固定是治疗累及臼顶的髋臼后壁骨折的关键,其手术入路及内固定方式的选择较多,但尚无统一意见。目前主要的手术入路有K-L入路联合大转子截骨、不需截骨的改良Gibson入路和K-L入路联合部分近端Watson-Jones切口入路等,内固定方式包括弹性钢板联合重建钢板、双钢板系统等。该文就累及臼顶的髋臼后壁骨折的诊断及预后、手术入路及内固定方式选择的研究进展进行综述。     

平行双重建钢板固定治疗髋臼后壁骨折

目的：探讨平行双重建钢板固定方法治疗髋臼后壁骨折的临床疗效。方法从2006年1月至2012年12月,手术治疗有明显移位的髋臼后壁骨折57例。手术全部采用Kocher-Langenbeck入路,骨折复位后均采用2块平行重建钢板固定,其中靠近臼缘的一块钢板,且尽量与臼缘弧度一致;另一块钢板与前一钢板平行,位于后壁应力集中区。结果所有患者骨折全部愈合,采用 Matta的 X线评估复位标准和改良的d’Aubign＆#233;和Postel的评分系统进行临床结果评估。57例中X线评估优43例,良10例,一般4例;临床结果优45例,良8例,一般2例,差2例。患者性别、髋关节脱位、边缘压缩骨折、骨折粉碎情况与临床结果无明显相关性,骨折复位差、严重异位骨化和股骨头坏死与临床结果相关且差异有统计学意义,是影响治疗的危险因素。结论使用平行双重建钢板固定治疗髋臼后壁骨折,是一个有效的手术治疗方法。固定方法简单,手术创伤小,预后佳,将会为临床治疗髋臼后壁骨折提供一个新的选择方法。     

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。     

60例复杂髋臼后壁骨折的诊治

目的探讨复杂髋臼后壁骨折的诊断及手术疗效。方法自2008年1月至2013年3月,以三种体位X线平片、CT扫描、CT三维图像重建技术诊断髋臼后柱合并后壁骨折42例、横形骨折合并后壁骨折18例。采用俯卧位Kocher-Langenbeck入路,开放复位髋臼重建接骨板和拉力螺钉固定,治疗复杂髋臼后壁骨折。结果按Matta评定标准,骨折解剖复位率80.49%、满意复位率8.54%、不满意复位率10.97%。术后早期并发症:坐骨神经损伤1例,股神经损伤1例,髂外动脉损伤血栓形成1例,下肢深静脉血栓形成2例;晚期并发症:异位骨化3例,股骨头坏死1例,髋关节创伤性关节炎2例。结论复杂髋臼后壁骨折正确诊断主要依靠骨盆前后位、闭孔斜位、髂骨斜位X线平片检查,对于判断髋臼骨折部位、类型非常重要,CT扫描提供髋臼冠状面骨折线、骨折块等清晰图像,为复杂髋臼后壁骨折的治疗,提供选择手术入路和内固定术方案有重要意义。     

骨盆重建钢板结合分叉钢板内固定治疗髋臼后壁骨折的疗效分析

目的探讨骨盆重建钢板结合分叉钢板内固定治疗髋臼后壁骨折的手术治疗效果。方法自2010-05—2012-08采用骨盆重建钢板结合分叉钢板内固定治疗15例髋臼后壁骨折。选用4孔以上的1/3管型钢板将最后1孔折弯至60°~85°,并把折弯部分修剪成叉,钢板塑形,轻度过弯,保留一定的弹性及长度,至少确保能上1枚螺钉。结果 15例均获得随访6~30个月,平均15个月。按Matta X线复位标准：解剖复位9例,满意复位5例,不满意复位1例。髋关节功能根据Matta改良的dAubigne-Postel评分标准评定：优9例,良4例,可2例。出现创伤性关节炎1例,移位骨化2例。1例出现腓总神经麻痹,经非手术治疗4个月后完全恢复。末次随访发现1例复位后骨折移位4 mm,考虑为伤后至手术时间过长,局部骨痂影响准确复位。结论骨盆重建钢板结合分叉钢板内固定治疗髋臼后壁骨折利用髋臼结构的力学原理,创伤较传统手术少,可最大限度修复髋臼结构及恢复髋关节功能,减少致残率,值得在临床中推广使用。     

Single versus double column fixation in transverse fractures of the acetabulum: A randomised controlled trial

IntroductionBiomechanical studies have compared fixation methods in transverse acetabular fractures, yet there is not enough clinical data to suggest an optimal fixation method. The aim of this randomized controlled trail was to compare fracture stability in posterior plating alone versus posterior plating and anterior column lag-screw fixation in treatment of transverse and transverse with posterior wall acetabular fractures.MethodsThirty patients were randomized to one of two groups, either posterior fixation alone (single column group), or posterior plating and anterior fixation with percutaneous anterior column screw (double column group). Patients were followed up with serial radiographic assessments documenting any loss of reduction, utilizing Matta’s radiological criteria, measuring the roof arc angles and by measuring any change in the femoral head offset.ResultsFifteen patients were randomized to each group. Mean patient age was 31 years, mean follow up period was 19 months (range 12–24). There was no significant differences between the two groups with regards the quality of post-operative reduction, blood loss, hospital stay and functional score using the modified Merle D'Aubinge and Postel score. The operative time was significantly longer in the double column fixation group (130 min versus 104 min). There was no loss of reduction observed in either of the two groups.ConclusionSingle poster column fixation in transverse and transverse posterior wall fractures showed similar result to double column fixation, in terms of fractures stability in the follow up period, quality of reduction and early functional outcome.     

大转子后半截骨在髋臼骨折手术显露中的应用

目的 探讨大转子后半截骨在涉及臼顶后上部的髋臼骨折手术显露中的作用.方法 2000年1月至2008年1月收治32例涉及臼顶后上部的髋臼骨折患者,其中28例获得随访,男16例,女12例;平均年龄39.9岁(16～73)岁;新鲜骨折19例,陈旧性骨折9例.所有患者均采用大转子后半截骨入路进行显露,采用髋臼三维记忆内固定系统固定髋臼骨折及大转子截骨块.结果 28例患者术后获平均48.9个月(19～95个月)随访.根据Matta标准:解剖复位17例,满意复位10例,不满意复位1例.所有髋臼骨折均一期愈合,未出现骨折移位.所有截骨块均获骨性愈合,平均愈合时间为14周.无骨不连、截骨块近端移位、内固定松动、断裂及深部感染等并发症发生.其中1例患者髂腹股沟切口发生浅表感染,经定期换药后切口二期愈合;2例患者骨折愈合后出现内固定刺激征,术后6个月取出大转子部位内固定.外展肌力根据美国医学研究委员会分级系统评定:4级3例,3级1例,其余患者肌力末受明显影响.采用d'Aubigne & Postel 临床分级标准评定髋关节功能:优10例,良15例,可2例,差1例,优良率为89.3%.结论 大转子后半截骨入路能够提供可靠的臼顶后上部显露,可以满足髋臼骨折的复位要求.

Abstract：

Objective To explore whether posterior trochanteric osteotomy can provide adequate exposure to facilitate surgery for acetabular fractures.Methods From January 2000 to January 2008, 32 cases of acetabular fracture involving the acetabular dome underwent posterior trochanteric osteotomy for a better exposure to facilitate internal fixation with acetabular tridimensional memory fixation system(ATMFS).Of the 32 cases, 28 were followed up.They were 16 men and 12 women, with a mean age of 39.9 years (16 to 73) .There were 19 fresh fractures and 9 old ones.Results Twenty-eight cases were followed up for an average of 48.9( 19 to 95) months .According to Matta criteria, anatomical reduction was achieved in 17 cases, satisfactory reduction in 10 cases, and unsatisfactory reduction in one old fracture.All the fractures got direct bony union with no displacement or deep infection.All the osteotomy fragments healed within 14 weeks without any nonunion, proximal migration, loosening or breakage of hardware or deep infection.Superficial infection occurred in one patient but healed after regular dressing.Two patients had to sustain removal of the implants from greater trochanter because of irritation.According to the Medical Research Council (MRC) grading system, the strength of the abductors was of Grade 4 in 3 patients, of Grade 3 in one patient and normal in the rest.By the modified d'Aubigne & Postel scoring system, the excellent to good rate was 89.3%.Conclusion Posterior trochanteric osteotomy can provide an adequate exposure of the acetabular dome without such complications as nonunion, proximal replacement or weakness of the abductors which often occur after the conventional oblique osteotomy.     

The Role of Surgical Hip Dislocation in the Treatment of Acetabular and Femoral Head Fractures

Abstract Background and Purpose: Surgical hip dislocation by trochanteric flip osteotomy facilitates access to acetabular and femoral head fractures. Furthermore, it allows evaluation of cartilage damage and vascularity of the femoral head. In this study the potential benefits of this procedure for improved fracture management and for prognostic assessment were investigated. Patients and Methods: From July 1997 to October 1999, 20 selected patients with displaced acetabular fractures (n = 12), femoral head fractures (n = 7), or combined injuries (n = 1) were included. Inclusion criteria for acetabular fractures were either displaced posterior wall fragments with cranial extension or complex acetabular fractures involving a displaced transverse fracture line. Open reduction and fixation of either complex acetabular fractures or femoral head fractures were carried out through Kocher-Langenbeck approach, trochanteric flip osteotomy, and complete surgical hip dislocation. Additionally, the extent of cartilage destruction and femoral head perfusion were assessed. Results: Anatomic reduction ( 1 mm displacement) of acetabular fractures was achieved in 69% of patients and good reduction ( 3 mm) in 31%. In patients with acetabular fractures, severe cartilage destruction of the acetabulum was found in 38% and of the femoral head in 15%, while patients with isolated femoral head fractures revealed severe cartilage damage of the femoral head in 57%. Arterial bleeding from the femoral head, tested by drilling, was observed in all patients. Secondary dislocation of the trochanteric osteotomy occurred in one patient and made refixation necessary. Patients were reexamined at least 2 years after intervention. 77% of patients with acetabular fractures and all patients with femoral head fractures showed good or excellent results after 32.6 ± 6.1 months according to the functional score of DAubigné & Postel. Conclusion: Surgical hip dislocation allows adequate reconstruction of complex acetabular and femoral head fractures and intraoperative evaluation of local cartilage damage and femoral head perfusion.     

髋臼骨折的手术治疗

目的 探讨髋臼骨折的分型、手术入路的选择及手术效果.方法 手术治疗22例髋臼骨折患者,后壁骨折和后柱加后壁骨折选择K-L入路,前柱、前壁骨折及横断骨折选择髂腹股沟入路,前后移位明显的横断骨折、T形骨折、双柱骨折选择前后联合入路.结果 22例均获随访,时间6个月~5年,骨折6~9个月均愈合.按Matta评定标准:解剖复位 9例,满意复位13例.根据改良的Merle d′Aubigne-Poster髋关节功能评分标准:优7例,良10例,可4例,差1例.1例股骨头坏死,3例创伤性关节炎,2例异位骨化.结论 按髋臼骨折的分型选择合适的手术入路和良好的骨折复位内固定是获得满意疗效的前提.     

Digastric trochanteric flip osteotomy and surgical dislocation of hip in the management of acetabular fractures

Objectives

To assess the efficacy and safety of digastric trochanteric flip osteotomy technique in the management of acetabular fractures and to evaluate surgical outcome in terms of fracture reduction, femoral head viability of selected acetabular fractures treated operatively using a digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with surgical dislocation of the femoral head.

Design

Prospective.

Patients

Eighteen patients predominantly with combined transverse and posterior wall fractures or multifragmentary posterior wall fractures.

Outcome evaluation

Clinical and radiographic analysis after a minimum 18 months follow-up.

Methods

A single modified approach involving digastric trochanteric flip osteotomy and a modified Kocher–Langenbeck approach with anterior (n = 14) or posterior (n = 4) surgical dislocation of the femoral head, was done for one or more of following reasons: intra-articular assessment of reduction in fractures with comminution, marginal impaction and involvement of the anterior column, removal of intra-articular fragments, and confirmation of extra-articular screw placement.

Results

At a mean follow-up of 26 months (18–40 months), the 17 patients presented with a good to excellent clinical result according to the d’Aubigné score. In all subjects, anatomical reduction was achieved during surgery. The osteotomy site healed at an average of 7 weeks and all the patients recovered abductor strength at 12 weeks. One avascular necrosis occurred in a case of posterior column plus wall fracture (who presented to us after 3 weeks). No heterotopic ossification interfering with hip function was found.

Conclusion

This technique gives good exposure (especially in posterior wall, dome area, posterior fracture-dislocation with intra-articular fragments/femoral head fractures and T-fractures), preservation of abductor strength (which may be lost with excessive retraction of abductors to see dome area in classical posterior approach), reliable healing of osteotomy (in contrast to conventional trochanteric osteotomy) without risking the vascularity of femoral head.     

Surgical hip dislocation in fixation of acetabular fractures: Extended indications and outcome

BackgroundSurgical hip dislocation has been described as an excellent method for reduction and fixation of acetabular fractures. It allows a 360-degree access to the acetabulum and acetabular dome. However, reproducibility of this technique is still a concern. The primary outcome of this study was to investigate the short term functional and radiological outcome with the use of surgical hip dislocation in acetabular fractures. The secondary outcome was to describe different indications and methods of reduction using this technique.MethodsThis is a retrospective consecutive case series for the use of surgical hip dislocation in acetabular fractures. Between July 2013 and February 2017, we used this technique to manage 36 cases of acetabular fractures. Two patients were lost to follow up leaving 34 patients eligible for the study. All surgeries were done by a 5-years and a 10-years’ experience surgeons in pelvic and acetabular trauma surgeries. Through Gibson approach, we used the technique of surgical hip dislocation as described by the Bernese group. Different methods of fracture reduction were used. Intraoperative grading of cartilage injury was done using Disler's grading system. Postoperative fracture reduction was evaluated using the criteria described by Matta. Clinical evaluation was done using the modified Merle d'Aubigne ? and Postel system.ResultsThe mean intra-operative blood loss was about 700 ± 35.4 ml. The mean units of blood transfused were 1 ± 0.1 unit. The mean surgical time was 135 ± 11.7 minutes.Anatomical reduction was achieved in 27 patients (79.4%). At a mean of 30 ± 16.8 months (median = 26 and IQR 22) follow up, the functional score was excellent in 5 (14.7 %), very good in 8 (23.5%), good in 9 (26.5%), fair in 2 (5.8%), and poor in 10 (29.4%) patients. Four patients (11.7%) developed AVN at a mean of 8 months postoperatively. Conversion to THA was done in 5 patients (14,7%). Trochanteric osteotomy showed osseous healing in all cases. No patient developed nerve injury or infection. One patient developed severe (grade III) heterotopic ossification.ConclusionsBesides the indications of surgical hip dislocation mentioned before as reduction of the anterior column in T and Transverse fractures, associated femoral head fractures, intraarticular fragments, and labral injuries, it can be used in other indications as entrapped posterior wall, roof impaction, pure impaction injuries and cranial extension of the posterior wall fractures. The technique is reproducible; however, the learning curve is steep and needs to be performed by experienced acetabular trauma surgeons.     

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.     

陈旧性髋臼骨折的手术治疗

目的:探讨陈旧性髋臼骨折手术治疗的方法及疗效评价.方法:2001年10月至2007年10月手术治疗陈旧性髋臼骨折26例,其中男21例,女5例;年龄18～65岁,平均35.6岁.按Letourne-Judet分型,后壁9例,横形3例,横形加后壁7例,后柱加后壁2例,T形2例,双柱3例.术前经骨盆CT三维重建明确诊断分型后,均采用手术治疗;伤后23～141 d手术,平均36.4 d.分别采用前、后入路,前后联合入路显露并复位,AO重建钢板内固定.结果:26例获得随访,时间6个月～8年,平均32.4个月.26例患者Matta评分:疼痛(5.04±1.04)分,活动度(5.23±0.76)分,行走情况(4.92±1.16)分,总分(5.06±0.99)分;其中,优6例,良10例,中6例,差4例.术后出现的外侧皮神经损伤3例,坐骨神经损伤2例,股骨头坏死1例,感染1例,异位骨化6例.结论:对陈旧性髋臼骨折的治疗要准确地进行术后评估,严格掌握手术指征,选择恰当的手术入路,正确的复位固定方法,可以获得相对满意的治疗效果.     

Assessment of trochanteric osteotomy fragment union after acetabular fracture surgery

BackgroundTrochanteric osteotomies are performed in conjunction with standard approaches to improve surgical exposure during open reduction and internal fixation (ORIF) of acetabular fractures. The literature on total hip arthroplasty reports nonunion rates as high as 30% associated with trochanteric osteotomies; however, few data exist regarding the outcomes of trochanteric osteotomies for acetabular fracture surgery. Our hypotheses were 1) patients receiving trochanteric osteotomies during ORIF of acetabular fractures have a low rate of nonunion of the osteotomy fragment, and 2) hip abduction precautions are not necessary with digastric type osteotomies.Patients and methodsA retrospective review was conducted to identify patients with acetabular fractures between July 2002 and June 2010 (n = 734 fractures) who required trochanteric osteotomies (n = 64, 9% of fractures). Forty-seven met inclusion criteria of adequate follow-up (>56 days). No excluded patient experienced a complication. Fractures were classified using the Letournel-Judet classification system.ResultsOnly seven (20%) of 35 patients who received digastric osteotomies had hip abduction precautions applied during the postoperative period. All study patients were shown to have radiographic union at the trochanteric osteotomy site (100% union rate, n = 47). Hip abduction precautions intended to protect the osteotomy site and reduce the risk of nonunion and fixation failure were infrequently applied to patients with digastric osteotomies (20%) in this cohort. Multiple protective factors against nonunion were present in this study population compared with previous arthroplasty studies from other institutions.ConclusionsTrochanteric osteotomies are not associated with a significant nonunion rate, and digastric osteotomies might be safely managed without hip abduction precautions.