髋臼骨折手术治疗的回顾性分析

目的 探讨髋臼骨折的诊断、手术方法及治疗效果. 方法 从1999年1月至2006年12月,共手术治疗髋臼骨折46例48髋,其中A型骨折18髋,B型骨折22髋,C型骨折8髋.手术采用髂腹股沟入路6髋,K-L入路27髋,前后联合入路(髂腹股沟+K-L入路)13髋,延长的髂股人路2髋. 结果 解剖复位32例(66.7%),复位满意11例(22.9%),复位不满意5例(10.4%).随访4个月～4年,平均2年5个月.按改良D'Aubigne和Postel评分标准评定关节功能:优26髋,良9髋,可9髋,差4髋,优良率为72.9%(35/48). 结论 术前CT三维重建对骨折准确分型和选择合理的手术入路具有重要作用;术前在骨盆标本上模拟手术并初步预弯重建钢板,对缩短手术时间、提高手术效果有很大帮助;术中对骨折在尽可能地解剖复位,并可靠内固定是取得良好疗效的基础.

Operative management of acetabular fractures: a retrospective analysis of 46 cases

Objective To discuss our experience of diagnosing and treating acetabular frac-tures. Methods From January 1999 to December 2006, a total of 48 acetabular fractures in 46 patients were treated surgically, including 18 hips of Type A, 22 hips of Type B, and 8 hips of Type C. Ilioinguinal approach was adopted in 6 hips, Kocher-Langenbeck approach in 27 hips, combined an-terior and posterior approach (Ilioinguinal plus Kocher-Langenbeck) in 13 hips, and extended iliofemoral approach in 2 hips. Results Anatomical reduction was obtained in 32 hips (66.7%), satisfactory reduction in 11 hips (22.9%) and poor reduction in 5 hips(10.4% ). All the cases were followed up for 4 months to 4 years, with an average of 29 months. They were evaluated according to D'Aubigne and Postel criteria for joint functions. Twenty-six hips were rated as excellent, 9 hips as fine, 9 hips as fair and 4hips as poor. The good-excellent rate was 72.9%. Conclusions CT three-dimensional reconstruction is a great help for a doctor to make accurate diagnosis of the type of complex acetabular fractures and thus select an appropriate operative approach. Preoperative simulation in vitro on a pelvic specimen also helps a doctor reduce operative time and improve operative rcsuhs. Maximal anatomical reduction and good internal fixation are es-sential for satisfactory outcome.