复杂粉碎性髋臼骨折关节面重建修复的策略及预后

目的探讨复杂粉碎性髋臼骨折手术修复方法及对软骨与骨性关节面愈合、关节功能的影响。方法 2006年4月至2010年5月,手术治疗髋臼复杂粉碎性骨折48例48髋,男39例,女9例;年龄21～70岁,平均36.2岁。均为严重关节内粉碎性骨折;选择髂腹股沟、后外侧或前后联合入路。术中粉碎严重的关节面（碎裂软骨下骨及未游离的关节软骨）利用股骨头作为模具、植骨支撑、镶嵌挤压、拉力螺钉加压及可吸收螺丝钉（聚左旋乳酸可吸收骨固定系统）固定、阻挡等方法拼接,完成折块与主体骨一体化,再应用骨盆重建接骨板固定。术后根据固定情况穿矫形鞋或皮牵引限制髋部活动4～6周,床上进行关节屈伸、收展功能锻炼,3个月后下床活动。结果所有患者随访11～22个月,平均14.6个月,骨折复位质量、影像学评价均采用Matta标准,X线片示骨折全部愈合,关节面平整,无明显塌陷及骨性游离体形成。临床功能评价采用d＇Aubigne-Postel标准：优44髋,良3髋,差1髋。结论以股骨头作为模具、应用植骨支撑、碎骨镶嵌挤压、拉力螺钉及可吸收螺钉固定阻挡等方法辅助完成复杂粉碎性髋臼骨折关节面的重建,可明显提高重建接骨板在严重髋臼骨折的复位、愈合质量,使髋关节获得满意功能。

Prognosis and reconstruction of articular surface in the complex acetabular comminuted fracture

Objective To investigate the repair methods of complex comminuted acetabular fracture and study the effects of them on the healing and function of cartilage and osseous joint.Methods 48 cases of complex comminuted acetabular fracture were treated from April 2006 to May 2010.Contained 39 males and 9 females,aged 21 -70 years,mean 36.2 years old.And all of them were serious intra - articular fractures.Groin.or around the joint posterior lateral were chosen to approach.Intraoperative crush severe joint surface（cracked subchondral bone and unionizedthe articular cartilage） were concatenated to complete the integration of off the block with the main bone by using the femoral head as a mold,bone supporting,embedded compression,compression lag screw and absorbable screws（bone fixed system could be absorbed by poly - L - lactic acid） fixing,blocking and etc.Then plate fixation was used to reconstruct the pelvic. According to the fixed condition.the patients were given orthopedic shoes or skin traction limits of hip activity for 4 - 6 weeks postoperative.Then the joint flexion and extension and,development of functional exercise were carried out on the bed.They were permitted to get out of bed and do proper exercises three month later.Results 48 hips followed up in 11-22 months,an average of 14.6 months,the quality of fracture reduction,radiographic evaluation are used Matta standard,X ray showed that the fractures were healed,articular surface was flat,no collapse and osseous loose bodies formation.Clinical features were evaluated using d,Aubigne - Postel Standard：excellent in 44 hips,good in 3,and poor in 1.Conclusion The application of femoral head as a mold bone supporting,bone fragments embedded compression, lag screws and absorbable screws could support the reconstruction of complex acetabular articular surface comminuted fracture, improve significantly the reestablishment and healing in severe acetabular fractures,and make satisfactory function of the hip joint.