36例髋臼骨折手术治疗的护理

髋臼骨折是一种负重关节内的骨折,多为高能量创伤引起,多数需要切开复位内固定治疗。自1998年1月~2005年6月,我科共手术治疗复杂髋臼骨折病人36例,现将护理体会介绍如下:1临床资料1.1一般资料:本组共36例,男25例,女11例,年龄18~62岁,平均年龄35岁。其中车祸伤28例。高处坠落伤8例。1.2治疗方法:本组病人采用硬膜外麻醉,其中31例采用髂腹股沟入路,5例采用联合入路,术后抗炎、对症治疗护理。本组病例中有2例发生淋巴瘘,采用髋关节制动,加压包扎,严格无菌换药,局部理疗,分别于手术后第6周、第7周切口愈合。其余均治疗满意,切口愈合良好。拆线后…     

复杂髋臼骨折的手术治疗

髋臼骨折作为少见的严重创伤，近年来随着交通业及建筑业的快速发展，高速、高能量创伤增多，其发病率逐年增加。髋臼骨折多为高能量损伤的关节内骨折，由于其复杂解剖特点，且移位大，复位困难，手术出血量多，所以过去多采用牵引等非手术治疗．但效果不佳，致残率较高。近年来随着开放内固定技术的进步，对有移位的髋臼骨折采用积极的早期切开复位内固定治疗目前已为大多数学者所认可。     

复杂型髋臼骨折的围手术期临床护理

复杂型髋臼骨折切开复位内固定是近几年来开展越来越多的大手术，手术创伤大，出血多。本院自１９９５年起共收治复杂型髋臼骨折２８例，均行切开复位内固定术。现将多年来配合手术的护理经验进行总结，报告如下。临床资料本组髋臼骨折２８例。其中男性１５例，女性１３例；左侧１３例，右侧１５例；平均年龄３８．９岁。受伤原因：车祸１５例，高处坠落伤８例，其它原因５例。均采用切开复位内固定手术治疗及术后功能锻炼，未发现一例由于护理不当而引起的并发症。护理体会１．术前护理：（１）向患者言明手术重要性、基本原理、术后注意事…     

复杂髋臼骨折脱位40例手术治疗及疗效分析

[目的]探讨提高复杂髋臼骨折手术治疗疗效的方法和要点.[方法]总结40例复杂髋臼骨折脱位的围手术期处理及手术治疗要点和治疗效果.充分做好围手术期的各项检查和治疗,做好术前和术后的病情评估.手术中根据不同的骨折类型,分别采用不同的入路[其中Kocher-Langenbeck入路21例,髂腹股沟入路6例,前后联合入路(髂腹股沟加K-L入路)13例],充分暴露骨折,准确复位,牢固内固定.[结果]平均随访时间为29个月(26 ～42个月).根据Matta影像学评分,解剖复位30例,良好复位7例,差3例;优良率92.5％.局部感染2例,发生创伤性关节炎4例,异位骨化1例.[结论]充分做好髋臼骨折围手术期的治疗和处理,是手术的必要条件;正确的手术入路和术中对骨折的良好复位固定,是提高治疗疗效的关键.     

髋臼骨折的手术治疗

目的：评价手术治疗髋臼移位骨折的效果。方法：总结对38例有移位髋臼骨折手术治疗的经验。根据骨折类型选用髂腹股沟入路、Kocher-Langenbeck入路、延长髂股入路，复位后用骨盆钢板和可吸收钉固定。结果：38例中22例（57.9%），完全复位，8例（21.05%）满意复位，8例（21.05%）复位不满意。30例获得随访，平均随访时间2.5年。根据Matta评分标准：优9例（30％),良13例（37％），一般6例（20％）。差4例（13％）。结论：对于髋臼骨折，联合应用三个方向的X片和CT扫描，准确诊断，尽早予以解剖复位，牢固固定，骨折愈合后负重运动。     

复杂髋臼骨折的手术治疗

目的探讨提高髋臼骨折复位质量的手术方法。方法自2005年3月至2010年3月,共手术治疗移位的复杂髋臼骨折26例,选择Kocher-langenbeck切口6例,髂腹股沟切口4例,扩大的髂股切口3例,前后联合切口13例。结果根据Matta提出的复位标准,本组解剖复位19例,良3例,差4例,复位优良率为84.6%(22/26);根据HHS(Har-ris hip score)疗效标准,所有26例中解剖复位组疗效优良率为84.2%(16/19),复位差组优良率为25%(1/4)。结论髋臼骨折的复位质量是决定手术疗效的关键,把握手术时机、正确选择切口、注意复位顺序、正确放置钢板并置入螺钉,是提高复位质量的关键。     

髋臼骨折的围手术期治疗对策

目的回顾分析我院治疗的髋臼骨折病例，探讨不同髋臼骨折的治疗方法。方法2000年7月至2007年6月共67例髋臼骨折患者采用不同的手术入路治疗，同时进行术后功能锻炼。结果随访6～43个月，按Matta标准评价髋臼复位质量，解剖复位50例，满意复位12例，不满意复位5例，优良率92．5％。髋关节功能参照改良的Merled’Aubigne标准评定：优49例，良9例，可7例，差2例，优良率86．1％。结论充分的术前计划、恰当的手术时机、正确的入路选择以及良好的术后锻炼是治疗髋臼骨折的有效方法。     

髋臼骨折治疗的先驱-Emile Letournel

Emile出生于北美洲的圣皮埃尔和密克隆群岛，这两个小岛位于纽芬兰海岸线的圣劳伦斯海湾。 20世纪60年代中期，Emile同自己的启蒙导师罗伯特·朱迪在一起工作，罗伯特·朱迪是Emile献身于矫形外科事业的一支催化剂。在那个时代，髋臼骨折的手术治疗仅仅限于后壁骨折的临时固定，而复杂髋臼骨折的切开复位内固定从未听说过。     

复杂髋臼骨折的手术治疗

目的 探讨采用不同手术入路治疗复杂髋臼骨折的疗效.方法 手术治疗复杂髋臼骨折26例,手术入路采用K-L切口6例,髂腹股沟4例,扩大的髂股1例,前后联合15例.结果 26例随访12～48个月,根据Matta的复位标准:解剖复位19例,良3例,差4例,复位优良率为22/26, 根据HHS疗效标准:解剖复位者疗效优良率为16/19,复位良者1/3,复位差者1/4.结论 髋臼骨折的复位质量是决定临床手术疗效的关键,正确选择切口、注意术中复位顺序、正确放置钢板和置入螺钉,是提高复位质量的关键.     

髋臼骨折后创伤性关节炎人工关节手术治疗新进展

目前髋臼骨折多主张解剖复位、坚强内固定和早期功能锻炼,不仅可以获得良好的临床疗效,还可减少或延缓创伤性关节炎的发生。因此认为切开复位内固定是髋臼骨折治疗的金标准。Letournel曾经制订了髋臼骨折的病理解剖、X线检查方法和骨折分类。然而对于髋臼粉碎性骨折、波及关节面的移     

Heterotopic ossification and other perioperative complications of acetabular fractures.

Thirty-eight operatively treated fractures of the acetabulum were evaluated retrospectively for perioperative complications. Functionally significant heterotopic ossification (Brooker class III or IV) developed in 23% of those patients who did not receive adequate prophylactic irradiation or indomethacin. Irradiation and indomethacin were effective in the prevention of severe heterotopic ossification. The development of severe heterotopic ossification (class III or IV) was associated with increased time from injury to operation. We conclude that prophylaxis against heterotopic ossification is warranted to decrease the incidence of this potentially preventable complication in patients who incur significant time delays prior to surgery. Other significant complications included avascular necrosis (26%), infection (13%), and neural injury (16%). Avascular necrosis developed in one patient who did not have a documented dislocation.     

髋臼骨折内固定失败术后的全髋关节置换术

目的:探讨髋臼骨折内固定失败术后继发创伤性关节炎和(或)股骨头缺血性坏死行全髋关节置换术的特点及临床疗效。方法:2009年2月至2014年10月,采用全髋关节置换术对31例(31髋)髋臼骨折内固定失败继发创伤性关节炎和(或)股骨头缺血性坏死患者进行治疗,其中男26例,女5例;受伤时平均年龄(41±12)岁。患者因髋臼骨折内固定术后3~132个月,平均(20.6±26.9)个月内继发创伤性关节炎和(或)股骨头缺血性坏死而行全髋关节置换术,全髋关节置换术均采用后外侧入路。观察术后并发症和关节活动度,并比较术前和术后随访时髋关节VAS疼痛评分和Harris髋关节评分。结果:术后27例获得随访,随访时间12~80个月,平均(43.2±11.7)个月。其中出现关节感染1例,假体松动1例,脱位1例,无继发坐骨神经损伤病例发生。所有随访病例髋关节功能和步态有明显改善;至末次随访时,VAS由术前平均(7.6±1.2)分,降低到术后平均(1.2±0.9)分,Harris评分由术前平均(45.5±13.6)分,提高到术后平均(88.5±7.8)分,差异均有统计学意义(P0.01)。髋关节除后伸外,前屈、外展、内收、内旋及外旋活动范围较术前显著增加,差异有统计学意义(P0.05)。X线片复查示:髋臼假体无不稳定发生,1例股骨柄假体下沉3 mm,2例发生异位骨化。结论:正确处理内固定物,提防潜在感染,合理重建髋臼骨缺损,是髋臼骨折内固定失败术后全髋关节置换成功的关键。     

Surgically treated acetabular fractures in adult patients

In this retrospective study, 27 acetabular fractures treated by open reduction and internal fixation with an average follow-up of 3.7 years (1.5–4.0) are reported. Reduction leaving a displacement of 2 mm was achieved in 9 hips (30%). Good or excellent results were obtained in 22 hips (82%), and in 2 patients who were referred to us after 3 weeks, we performed supra-acetabular osteotomy to obtain congruent joints with fairly good results. The most common complication was heterotopic ossification in 59% of the patients, which led to poor results in 2 patients with grade IV. Avascular necrosis of the hip occurred in 2 patients, and 1 patient developed a late deep infection, which led to osteomyelitis and fused hip.     

Management of acetabular fractures in elderly patients

Management of acetabular fractures in elderly patients is challenging. The challenges arise due to associated medical comorbidities, poor bone quality and comminution. There are multiple modalities of treatment. the exact algorithms or treatment remain undefined. Treatment is still based on experience and some available evidence. The options include conservative treatment, percutaneous fixation, open reduction internal fixation and the acute fix and replace procedure. There is a well recognised risk of each treatment option. We present a narrative review of the relevant available evidence and our treatment principles based on experience from a regional tertiary pelvic-acetabular fracture service.     

Management of acetabular fractures in elderly patients

Management of acetabular fractures in elderly patients is challenging. The challenges arise due to associated medical comorbidities, poor bone quality and comminution. There are multiple modalities of treatment. the exact algorithms or treatment remain undefined. Treatment is still based on experience and some available evidence. The options include conservative treatment, percutaneous fixation, open reduction internal fixation and the acute fix and replace procedure. There is a well recognised risk of each treatment option. We present a narrative review of the relevant available evidence and our treatment principles based on experience from a regional tertiary pelvic-acetabular fracture service.     

Operative treatment for acetabular fractures

We report a retrospective study of 54 acetabular fractures treated by open reduction and internal fixation, with an average follow-up of 9.6 years (3 to 17). Reduction leaving displacement of less than or equal to 2 mm was achieved in 36 hips (67%); good or excellent functional results were obtained in 33 patients (61%). Early complications requiring re-operation included postoperative loss of reduction in one case and an intra-articular screw in another. Arthrodesis or total hip arthroplasty had been performed in 10 patients (19%) who had late symptomatic degenerative changes. Failure to obtain accurate reduction was the most important factor leading to a poor result, but heterotopic calcification caused poor results in seven patients, five of whom had had an anatomical reduction.     

髋臼骨折治疗方法的选择

目的探讨髋臼骨折治疗方法的选择。方法42例髋臼骨折按Letoumel分类：Ⅰ型6例,ⅡA4例,ⅡB3例,ⅢA7例,ⅢB9例,ⅣA5例,ⅣB8例。手术采用K—L入路15例,髂腹股沟入路11例,髂股入路2例,前后联合入路5例;非手术治疗9例。结果42例均获得随访,时间4～30个月。X线片显示骨折均在12-16周愈合。根据美国矫形外科研究院评价髋关节功能标准：优24例,良10例,可6例,差2例,优良率80．95％。并发创伤性关节炎2例,异位骨化3例。结论早期对复杂髋臼骨折进行手术治疗,可获得满意的复位。选择合适的治疗方法对于减少手术创伤,准确复位骨折,减少手术并发症,促进关节功能恢复有重要意义。