34例髋臼复杂骨折的手术疗效分析

目的探讨髋臼复杂骨折手术治疗效果，提高其诊疗水平。方法回顾性分析2005年8月-2008年9月间手术治疗的34例髋臼复杂骨折患者病史资料，男25例，女9例，平均年龄36．6岁。骨折按照Letounel分类：后柱伴后壁骨折2例，横形合并后壁骨折7例，T型骨折8例，前柱合并后半横形骨折4例，双柱骨折13例。对骨折进行切开复位钢板和螺丝钉内固定，其中髂腹股沟入路12例，Kocher—Langenbeck入路15例，髂股延伸入路1例，前后联合人路（Kocher—Langenbeck入路＋髂腹股沟入路）6例。结果34例全部获得随访，随访时间12—36个月（平均20个月），本组解剖复位19例，良好复位10例，复位较差5例。根据Matta临床评分标准：优15例，良9例，可7例，差3例。术后出现创伤性关节炎9例，股骨头坏死3例，异位骨化9例。结论早期手术、解剖复位、坚强固定、早期功能锻炼、积极预防并发症结合术者的经碍命是获得良好临床结果的关锌。

Surgical treatment outcome in 34 patients with complex acetabular fracture

Objective To study the surgical treatment outcome of complex acetabular fracture in order to improve its diagnosis and treatment. Methods Data about 34 patients （25 males and 9 females） with complex acetabular fracture at the average age of 36.6 years, who were treated with surgery in our hospital from August 2005 to September 2008, were retrospectively analyzed. Fractures were classified as posterior column combined posterior wall fracture in 2 patients, transverse combined posterior wall fracture in 7 patients, T-shaped fracture in 8 patients, anterior combined posterior hemitransverse fracture in 4 patients, and both column fracture in 13 patients, respectively, according to the Letournel classification. Fracture reduction and fixation were carried out with special instruments, plates and screws through Kocher-Langenbeck ＋ ilioinguinal approach in 15 patients, extended iliofemoral approach in 1 patient, combined anterior and posterior approach in 6 patients. Results All the patients were followed up for 12-36 months （mean 20 months）. Anatomical, satisfactory and poor reduction was achieved in 19, 10 and 5 patients, respectively. According to the Matta scores, excellent, good, fair and poor results were found in 15, 9, 7 and 3 patients respectively. Traumatic arthritis, femoral head necrosis and heterotopic ossification occurred in 9, 3 and 9 patients, respectively, after operation. Conclusion Early operation, anatomical reduction, good fixation, early functional rehabilitation, surgeon＇s experience and active prevention of complications are the keys to a good clinical outcome.