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。

Surgical treatment of acetabular posterior wall fractures

Objective: To analyze the clinical effect of acetabular posterior wall fractures with reconstruction plate internal fixation. Methods: From January 2001 to January 2006,45 cases were studied retrospectively including,31 males and 14 females. The age ranged from 19 to 68 years,mean 37.6 years. All patients of acetabular posterior wall fractures were treated by open reduction and internal fixation with reconstruction plate. All patients were reviewed retrospectively. All patients were treated with the Kocher-Langenbeck approach. Results: Forty-five patients were followed up for 12 to 48 months,averaged 26 months. By Matta's X-ray reduction criteria,there were 38 cases of anatomical reduction,7 cases of satisfactory. By modified d'Aubigne clinical evaluation criteria,the clinical results were excellent in 30 cases,good in 10 cases and fair in 5 cases,excellent and good rate of clinical results was 88.9%. There were no infection and non-union. The complications included traumatic osteoarthritis in 4,aseptic necrosis of the femoral head in 2,heterotopic osteogenesis in 2 and deep venous thromboembolism in 1. Conclusion: Fractures of acetabular posterior wall with reconstruction plate internal fixation can gain good clinical results. The quality of fracture reduction,the time to surgery after injury,experience of surgical operation and the degree of fracture comminution are the factors influencing the operative results of posterior wall fractures of the acetabulum.