髋臼骨折的手术治疗

目的探讨髋臼骨折的手术适应证、手术入路、术后处理及并发症防治。方法1998-01～2005-01,分别采用Kocher-Langenbeck入路,髂腹股沟入路和Smith-Peteron入路,前或后入路,以及前后联合入路或扩大的髂股入路,手术治疗87例髋臼骨折患者。其中,车祸伤74例,高处坠落伤13例。急性损伤78例,陈旧性损伤9例。根据Letournel分类,后壁骨折16例,其中合并股骨头后脱位7例;后壁骨折＋后柱骨折21例;前壁骨折＋前柱骨折12例;双柱骨折19例;髋臼横形骨折26例。结果术中未发生神经、血管损伤,术中或术后输血53例,输血200～3 500 mL。术后伤口无感染,4例表皮局部坏死,经换药后治愈。87例获随访1～5年,平均3.2年。按照美国骨科学会评价标准,优56例（64.36%）,良21例（24.13%）,可7例（8.04%）,差3例（3.4%）,优良率为88.49%。术后发生异位骨化5例,1例术后10个月发生股骨头坏死。结论有移位的髋臼骨折应尽早手术治疗,以恢复髋关节的稳定性、连续性及髋臼软骨面的光滑性,这对于髋关节功能恢复具有重要作用。

Operative Treatment of Acetabular Fracture

Objective To investigate the indication,operative approach,postoperative management,and complication of acetabular fracture.Methods Eighty-seven patients(59 males,28 females;age 17-68 years)with acetabular fracture were reviewed retrospectively.Among the patients,74 were injured in the traffic accidents and 13 were injured in the falls(acute injury in 78,old injury in 9).According to the Letournel classification,16 had afracture of the posterior wall,21 had afracture of the posterior wall and posterior column,12 had a fracture of the anterior wall and anterior column,19 had a fracture of the anterior and posterior column,and 26 had a transverse acetabular fracture.All the patients underwent an operative treatment.Results There was no injury to the nerves and blood vessels during the operation.According to the 1-5 year follow-up for 87 patients,56(64.36%)patients had anexcellent function,21(24.13%) had a good function,7(8.04%) had a fair function,and 3(3.4%)had a poor function.The excellent and good rate was 88.49%.After operation,heterotopic ossification was observed in 5 patients,and necrosis of the femoral headin 1 patients.Conclusion Operative management should be performed as soon as possible in the patients with a displaced acetabular fracture.Recovery of the stability of theacetabulum and smoothness of the acetabular articular cartilage is important to the recovery of the function.