髋臼骨折手术治疗后髋关节功能恢复的影响因素分析

背景：髋臼骨折多为高能量损伤所致,属于关节内骨折,手术是最佳治疗方式。但骨折类型、手术入路、复位质量、年龄、手术时机等会对治疗效果产生影响。因此,分析影响手术效果的关键因素十分必要。目的：探讨手术治疗髋臼骨折后影响髋关节功能恢复的因素。方法方法：选择2010年1月至2013年10月手术治疗且随访资料完整的髋臼骨折患者42例,18例采用Kocher-Langenbeck入路,14例采用髂腹股沟入路,10例采用前后联合入路。术后采用Matta标准评定骨折复位情况。采用改良的Merled＇Aubigne-Postel评分系统评价患者髋关节功能。对可能影响手术疗效的指标（如性别、年龄、手术时机、骨折类型、手术入路、复位质量等）进行单因素及多因素Logistic回归分析,筛查影响手术疗效的危险因素。结果：术后14例达到解剖复位,20例良好复位,8例一般复位。切口均甲级愈合,未出现感染。全部患者术后随访12-26个月,平均19个月。X线检查示骨折于术后10-18周愈合,平均14周。术后出现坐骨神经损伤4例,创伤性关节炎2例,股骨头缺血坏死2例,异位骨化7例。术后6个月时髋关节功能评定为优13例,良21例,可5例,差3例,优良率为81%。单因素分析结果显示性别、年龄、手术入路、髋关节脱位与手术疗效无明显关系（P〉0.05）,而手术时机、骨折类型、复位质量、异位骨化与手术疗效有关（P〈0.05）。多因素分析显示骨折类型、手术时机、复位质量是影响手术效果的独立因素（P〈0.05）。结论：骨折类型、手术时机和复位质量是影响髋臼骨折手术疗效的独立因素,而后两者是相对可控的因素,治疗时要选择合适时机、尽量达到解剖复位,以期获得良好的临床结局。

Influential factors of hip joint function recovery after surgical treatment for acetabulum fracture

Background： Acetabular fracture is intraarticular fracture and mostly caused by high-energy injury. Surgical management is thought the best choice of treatment therapy. It is thought that the classification of fracture, surgical approach, quality of reduction, age and time of surgical treatment may influence the clinical outcome of treatment. So it is essential to explore the key influential factors related to therapeutic effect.Objective： To explore influential factors of recovery of hip joint function after surgical treatment for acetabulum fracture.Methods： A total of 42 patients with acetabulum fracture treated in our hospital between January 2010 and October 2013 were enrolled in the retrospective study. Open reduction and internal fixation were performed in 18 cases through KocherLangenbeck approach, 14 cases through iliac inguinal approach, 10 cases anterior and posterior approach. The reduction quality was assessed by the Matta standard. The function of hip joint was evaluated by modified Merled＇ Aubigne- Postel grading system. Logistic regression analysis for single factor and multiple factors was used to screen risk factors, such as gender, age, operation time, fracture type, surgical approach, reduction, etc） related to surgical curative effect.Results： Anatomical reduction was achieved in 14 cases, good reduction in 20 cases and fair reduction in 8 cases. Primary healing was seen in all incisions and no infection occurred. The mean period of follow- up was 19 months（range, 12- 26months）. The mean fracture healing time was 14 weeks（range, 10-18 months）. Injury of sciatic nerve occurred 4 cases, traumatic arthritis in 4, ischemic necrosis of femoral head in 2, and heterotopic ossification in 7. The hip joint function was excellent in 13 cases, good in 21, fair in 5, and bad in 3 at 6 months after surgery. Single factor analysis showed that gender,age, surgical approach, or dislocation of hip joint had no significant relation with therapeutic effect（P〉0.05）, but operationtime, f