内固定治疗移位髋臼骨折的疗效分析

目的 探讨内固定治疗移位髋臼骨折的疗效.方法 2004年7月至2009年4月共收治64例移位髋臼骨折患者,男40例,女24例;平均年龄47.6岁.按Letournel-Judet方法分型:后壁骨折16例,后柱骨折2例,前柱骨折2例,横行骨折8例,后柱伴后壁骨折8例,横行伴后壁骨折6例,T形骨折6例,前柱伴后壁横行骨折2例,双柱骨折14例.根据不同骨折类型,手术采用Kocher-Langenbeck(K-L)入路32例,髂腹股沟入路16例,前后联合入路(髂腹股沟切口+K-L入路)16例,复位后应用骨盆重建钢板、拉力螺钉内固定. 结果 平均手术时间为3 h,术中平均失血量为800mL.所有患者术后获8～40个月(平均18个月)随访.根据Matta影像学评分,患者伤后2周内手术者53例,其中解剖复位39例,满意复位10例,不满意复位4例,复位优良率为92.5%.伤后2～3周后手术者11例,其中解剖复位4例,满意复位5例,不满意复位2例,复位优良率为81.8%.临床疗效评定结果:优37例,良13例,可8例,差6例,优良率为78.1%.发生创伤性关节炎2例,异位骨化3例(Ⅱ～Ⅲ度),股骨头缺血性坏死1例. 结论 对于移位髋臼骨折,根据不同骨折类型采用不同开放复位策略、尽早选择合理的手术方法是提高疗效的关键.

Internal fixation for displaced acetabular fractures

Objective To explore surgical treatments of displaced acetabular fractures. Methods From July 2004 to April 2009, based on their X-ray and computed tomography, 64 patients with acetabular fractures were classified by the Letournel-Judet classification. Kocher-Langenbeck (K-L) approach was applied in 32 cases, ilioinguinal approach in 16, and combined K-L and ilioinguinal approaches in 16. Pelvic reconstructive plates or screws were implanted. The mean operation time was 3 hours. The average blood loss was 800 mL. The Matta radiographic grading was used to evaluate the outcomes. Results All the patients were followed up from 8 to 40 months, averaging 18 months. Of the 53 patients who had received surgery within 2 weeks after injury, 39 obtained anatomic reduction, 10 satisfactory reduction, and 4 unsatisfactory reduction, with an excellent to good rate of 92. 5%. Of the 11 patients who had received surgery from 2 to 3 weeks after injury, 4 obtained anatomic reduction, 5 satisfactory reduction and 2 unsatisfactory reduction, with an excellent to good rate of 81.8%. Traumatic osteoarthritis occurred in 2 cases, heterotopic ossification in 3,and avascular necrosis of the femoral head in one case. Conclusion Early surgery and suitable surgical approaches for reduction and internal fixation are crucial factors for improving therapeutic effects in the treatment of displaced acetabular fractures.