影响髋臼后壁骨折手术疗效的分析

目的 分析影响手术治疗髋臼后壁骨折疗效的因素并总结治疗经验. 方法 1993年8月至2006年8月手术治疗且符合纳入标准髋臼后壁骨折患者105例,用改良的Merle d'Aubigné和Postel评分系统评价临床效果,用Matta放射学标准评价影像学结果.通过统计分析说明年龄、性别、受伤至手术时间、合并伤、髋关节脱位情况、是否存在边缘压缩、骨折复位质量、有无合并股骨头骨折,异位骨化程度和有无股骨头坏死等与临床效果间的关系. 结果所有患者平均随访4.1年(2.0～10.6年).临床效果:优32例,良56例,可11例,差6例,优良率83.8%(88/105).影像学结果:优52例,良36例,可12例,差5例,优良率83.8%(88/105).患者年龄、性别、受伤至手术时间、合并伤及髋关节脱位与临床效果无显著相关.存在边缘压缩、合并股骨头骨折、骨折复位差、严重异位骨化和股骨头坏死与临床效果显著相关.临床效果与影像学结果存在强相关性(Kappa=0.772). 结论术中仔细探查、解剖复位、牢靠固定是关键.存在边缘压缩骨折、骨折复位差、合并股骨头骨折、严重异位骨化和股骨头坏死是影响治疗效果的主要因素.

Treatment of fractures of the posterior wall of the acetabulum

Objective To analyze factors which may affect the operative outcome of the posterior wall acetabular fracture retrospectively. Methods In this retrospective study we included 105 patients who had received open reduction and internal fixation for fracture of the posterior wall of the acetabulum from August 1993 to August 2006. All patients were followed up for a mean of 4.1 (range, 2.0 to 10.6) years. Their functional outcomes were evaluated using a modified clinical grading system developed by Merle d' analyses were done to detect associations between clinical outcomes and age, time from injury to surgery, gender, complicated injury, hip dislocation, marginal impaction, reduction, complicated femoral head frac-ture, ectopic ossification and necrosis of femoral head. Results The radiographic result was excellent in 52 patients, good in 36, fair in 12, and poor in 5. The clinical outcome at the time of final follow-up was graded as excellent in 32 patients, good in 56, fair in 11, and poor in 6. There was no obvious association between clinical outcomes and age, time from injury to surgery, gender, complicated injury and hip disloca-tion, but there was obvious association between clinical outcomes and marginal impaction, reduction, com-plicated femoral head fracture, ectopic ossification and necrosis of femoral head. There was a strong associa-tion between clinical outcomes and radiographic grading (Kappa = 0.772) . Conclusions Careful ex-amination, anatomic reduction and stable fixation are keys to a successful operation. Marginal impactian, poor reduction, fracture of femoral head, severe heterotopic ossification and osteonecrosis are risk factors leading to unsatisfactory clinical results.