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.

Surgical therapy of displaced complex acetabular fractures and analysis of influence factors in 40 patients

[Objective] To summarize the surgical therapy of displaced complex acetabular fractures and discuss the factors influencing results and the methods to improve effect.[Method]Preoperative preparation must be done.According to classification of acetabular fractures,40 cases of complex type of acetabular fracture with dislocation were treated with open reduction and internal fixation with reconstruction plates.Kocher-Langenbeck approach was adopted in 21 cases,ilio inguinal approach in 6 cases,and anterior combined with posterior approach in 13 case.[Result]All cases were followed up for 26-42 months.We assessed the reduction quality with Matta radiographic grade.The function of hip joint was assessed.Thirty cases were excellent,7 good,3 fair,and the rate of excellence and good results was 92.5%.Infection was observed in 2 casee,Traumatic arthritis was found in 4 cases,heterotopic ossification in 1 case.[Conclusion]According to our experience,accurate preoperative analysis of fractures,reasonable surgical approaches,high reduction quality,effective fixation are essential to good treatment of acetabular fractures.