Letournel分型复杂髋臼骨折的手术治疗

目的探讨Letournel分型复杂髋臼骨折的诊断和治疗。方法75例Letournel分型复杂髋臼骨折，术前经骨盆CT三维重建明确诊断分型后，分别采用前、后人路，前后联合入路及笔者改良的髂股入路显露并复位，AO重建钢板内固定。结果随访6个月～8年，平均3年10个月，按关节功能D’Aubigne和Postel6分法及X线片表现Epstein标准评价，优34例，良28例，可8例，差5例，优良率为82．57％。结论术前完善的影像学资料、骨盆模型标本的体外模拟、使用合理的手术入路、术中尽可能的解剖复位及AO重建钢板内固定是获得良好结果的基础。

Operative management of complex acetabular fractures of Letournel classification

Objective To discuss the diagnosis and operative treatment of the complex acetabular fractures of Letournel classification. Methods On the basis of the three- dimensional computed tomography, 75 cases of complex acetabular fractures were diagnosed and classified according to Letournel classification. They were treated through the anterior, posterior, combined anterior- posterior and the improved iliofemoral approaches. All the fractures were fixed with screws and AO reconstruction plates. Results All the cases were followed up for 6 to 96 months, with an average time of 46 months. They were evaluated according to D' Aubigne and Pestel criteria for joint functions and Epstein criteria for radiographic manifestation. 34 cases of the series were rated as excellent (45.23% ), 28 case as fine (37.33% ), 8 cases as fair (10.67% ) and 5 cases as poor (6.67% ). Conclusion Enough image data, simulation in vitro on a pelvic specimen, maximal anatomical reduction and appropriate approach are the basis for satisfactory outcomes.