自体游离髂骨移植治疗髋臼后壁骨折缺损临床观察

目的探讨自体游离髂骨移植重建髋臼后壁在治疗髋臼后壁骨折缺损中的应用.方法回顾分析2003年2月至2006年8月5例髋臼后壁骨质缺损病例,男4例,女1例;年龄22～46岁,平均31.8岁.均为车祸仪表盘损伤.骨折采用Judet-Letoumel分型,在后壁三个亚型中为Ⅰ型1例、Ⅱ型3例、Ⅲ型1例.手术均采用自体游离髂骨移植重建髋臼后壁骨折缺损.其中3例为3周内手术,1例为固定失效再手术,1例为陈旧骨折.结果平均手术耗时为90 min（60～120 min）,术中术后无并发神经损伤,所有病例经过随访7～24个月,平均18个月;平均骨折愈合时间为16周（11～20周）.无术口感染、内固定失效、继发骨折及卧床并发症的发生.1例发生异位骨化,1例术后18月发生股骨头坏死.结论用髂骨植骨的手术方法,虽然不能完全恢复髋臼原有的形态,但对于青壮年患者,满足一段时间内的正常生活还是有益的,也为二期发生股骨头坏死全髋关节置换创造了条件.

Surgical Treatment for Bone Defect in Posterior Wall of Acctabulum with Free Ilium Transplantation

Objective To investigate the application of free ilium transplantation in the treatment of bone defect in the posterior wall of the acctabulum.Methods We reviewed five patients with bone defect in the posterior wall of the acctabulum between February 2003 and August 2006,there were 4 male and 1 female petients,the mean age was 31.8（from 22 to 46）,and they were all injuried by instrument panel in traffic accident.By Judet-Letoumel classification,there were 1 case of typeⅠ,3 cases of typeⅡ and 1 case of type Ⅲ in the posterior wall hypotype.The fracture and defect of the posterior wall of the acctabulum was reconstructured with free ilium transplantation by himself.3 patients received surgery in three weeks,1 patient received the second surgery after fixation failure,and 1 patient had neglected fracture.Results The mean operation time was 90 minutes（between 60 to 120 minutes）.There were no nerve nerve injury during operation and after operation.The mean follow-up was 18（7 to 24）.The mean time of bone healing was 16（11 to 20）weeks.There were no complications of incision infection,fixation failure,secondary fracture and lying in bed complication.There were one patient with heterotopic ossification and one patient with the osteonecrosis of the femoral head after 18 months.Conclusion Although ilium transplantation can＇t make the acetabulum completely recover to the original shape,but it is beneficial to the normal life of yong patients,and can create the condition for secondary total hip replacement in patients with osteonecrosis of the femoral head.