髋臼骨折手术治疗的并发症

目的总结分析手术治疗髋臼骨折的并发症。方法1994年1月～2004年1月,我院行髋臼骨折切开复位内固定术46例。合并髋关节脱位或股骨头骨折的患者术后行骨牵引3～4周,术后3d开始髋关节被动活动和股四头肌功能锻炼。8～16周逐渐扶拐下地行走,16～24周逐步进行负重活动。所有患者术毕给予吲哚美辛口服,剂量为25mg,每日2次,持续3个月。有坐骨神经损伤的患者,给予神经营养药对症处理。为预防下肢血栓性静脉炎,对老年及高危患者术后预防性使用肝素等抗凝剂,出院后继续使用华法令等抗凝剂3～4周,直至能主动。结果本组优28例,良9例,一般5例,差4例,优良率为80.4%。本组病例中1例发生深部感染,11例术后发生异位骨化。术前6例合并坐骨神经损伤的患者中4例有不同程度的恢复。本组有3例合并下肢血栓性静脉炎,经抗凝剂治疗,2例已完全康复。本组有6例出现股骨头缺血性坏死,其中有4例已行人工髋关节置换术。结论对于绝大多数移位的髋臼骨折应以手术治疗为主,但应注意并发症的防治。

Complications in operative treatment of acetabular fractures

Objective To sum up our clinical experience of managing complications in operative treatment of 46 acetabular fractures in our hospital. Methods 46 cases of acetabular fractures accepted open reduction and internal fixation (ORIF) in our hospital from 1994 to 2004. Skeletal traction was applied for 3 to 4 weeks. Continuous passive motion of the hip joint and the exercise of the femoral quadriceps started on the third postoperative day. Indomethacin was used prophylactically to prevent heterotopic ossification. At first, the patients were confined to bed for 8 weeks, and then partial weight bearing for 8 weeks was recommended. The patients were allowed full weight bearing over the next 8 weeks.For the patients with sciatic nerve injury, nerve nutrition drugs were applied routinely. In order to prevent deep venous thrombosis (DVT), partial anticoagulation with heparin was applied for old and high risky patients following surgery, typically for 3 to 4 weeks. Results In this study, excellent results were reported in 28 cases, good in 9, fair in 5, and poor in 4, the excellent and good rate was 80.4% . Deep infection occurred in only one case which was treated with debridement and lavage. Heterotopic ossification occurred in 11 cases. Of the 6 patients with sciatic nerve injury before surgery, 4 experienced improvement. In this group 3 cases suffered from DVT and were given anticoagulation. 2 cases of them recovered and the symptom lasted more than half a year in the remaining one. 6 cases experienced avascular necrosis of the femoral head, and 4 of them accepted total hip arthroplasty (THA). Conclusion For most displaced acetabular fractures, open reduction and internal fixation (ORIF) is still a proper procedure, but care should be taken to prevent associated complications. [