联合入路治疗复杂髋臼骨折的预后及影响因素分析

目的 回顾性研究采用前后联合入路治疗复杂髋臼骨折患者的预后及影响因素. 方法自2000年1月至2006年8月采用前后联合入路治疗且获得2年以上随访的复杂髋臼骨折患者共28例(28髋),对患者术后进行复位质量和远期影像学评价.根据改良的Merle d'Aubigné和Postel评分标准及SF-36简便型健康调查问卷(MOS SF-36)对患者的髋关节临床功能和生命质量进行评估.分析本组患者与一般人群的生命质量有无差异,预后因素与功能结果的相关性. 结果所有患者平均随访31个月(14～82个月),影像学评估显示术后初始影像显示解剖复位17例(60.7%),良好复位9例(32.2%),差复位2例(7.1%).远期影像学结果:优16例,良7例,可3例,差2例,优良率82.1%(23/28).发生异位骨化18例(64.3%),股骨头缺血坏死2例(7.1%).改良Merle d'Aubigné和Postel平均得分15.5分(10～18分).优4例,良18例,可4例,差2例,优良率78.6%(22/28).对于复杂髋臼骨折患者,生命质量在一般健埭状况、生命力、情感角色和心理健康等4个维度与一般人群差异无统计学意义(P>0.05),在躯体功能、躯体角色、机体疼痛和社会功能等4个维度较一般人群下降(P<0.05).复位质量是髋臼骨折预后最重要的可控性因素(r=0.564,P=0.001). 结论联合入路治疗复杂髋臼骨折,能提供良好的显露,有利于骨折的复位和固定,预后良好.影响髋臼骨折预后的因素众多,但复化质量是其中最重要的可控性因素.

Prognosis of complex acetabular fractures treated by combined approaches

Objective To evaluate the outcomes and their influencing factors of treatment of complex acetabular fractures by combined approaches. Methods From January 2000 to August 2006, 31 patients with complex acetabular fractures were operated on by combined ilioinguinal and Kocher-Langenheck ap-proaches. Of them, 28 patients, 19 males and 9 females, were followed up for an average of 31 (14 to 82) months. Their average age was 40 (20 to 75) years. Postoperative reduction quality and long-term radio-graphic results were evaluated according to the Matta radiological systems. The modified Merle d' Aubigne-Postel hip scoring system was used for the functional outcomes. The MOS SF-36 was used to evaluate the quality of life. Results Reduction was anatomical in 17 cases (60.7%), good in 9 cases (32.2%), and poor in 2 cases (7.1%) . Radiographic long-term results were excellent in 16 cases (57.2%), good in 7 cases (25 %), fair in 3 cases (10.7%) and poor in 2 cases (7.1%). Heterotopic ossification occurred in 18 patients (64. 3%), with Brooker Class Ⅰ in 8 (28.6%), Class Ⅱ in 7 (25.0%) and Class Ⅲ in 3 (10. 7%). Osteonecrosis of the femoral head occurred in 2 patients (7.1%). The mean Merle d' or poor. In comparison with local general people, the domains of general health, vitality, emotional role and mental health in patients with complex acetabular fractures treated by combined approaches were intact (P>0.05); however, the domains of physical function, physical role, body pain and social function had significantly lower scores(P<0.05) . Conclusions Indications for the combined approaches are limited to complex fracture patterns involved both columns, such as both column fractures, transverse and posterior wall fractures and T-type fractures, for which anatomical (or good) reduction or rigid internal fixation cannot be achieved by a single approach. The quality of reduction is a crucial and controllable prognostic factor.