经顶型移位髋臼横形骨折手术疗效分析

目的 探讨手术治疗经顶型移位髋臼横形骨折的疗效及其影响因素.方法 1990年5月至2006年7月,手术治疗经顶型移位髋臼横形骨折37例,男26例,女11例;年龄22～64岁,平均34岁.根据复位质量、臼顶骨折粉碎程度、髋关节稳定性、股骨头软骨损伤等因素进行分组,按Matta术后X线复位标准和放射学评估标准及改良的Merle d'Aubigne和Postel功能评分标准进行评估.结果 所有患者均获随访,随访时间16～121个月,平均88.6个月.术后解剖复位31例,复位欠佳4例,复位差2例.2例患者术后X线片示髋关节不稳.根据改良的Merle d'Aubigne和Postel功能评分,临床疗效:优16例(43.24%),良14例(37.84%),可4例(10.81%),差3例(8.11%),优良率为81.08%;远期随访MattaX线疗效:优14例(37.84%),良15例(40.54%),可4例(10.81%),差4(10.81%),优良率为78.38%.临床疗效与X线疗效存在相关性.临床优良率在解剖复位和非解剖复位组分别为90.32%和33.33%,在臼顶粉碎性骨折和非粉碎性骨折组分别为58.33%和92.00%,在髋关节不稳组和稳定组分别为0和85.71%,在股骨头软骨损伤和无软骨损伤组分别为42.86%和90.00%.结论 骨折复位不佳、臼顶粉碎性旨折、髋关节不稳及股骨头软骨损伤等因素可直接影响经顶型移位髋臼横形骨折的手术疗效.

Analysis of operative treatment of displaced transverse acetabular fracture involving weight-bearing dome

Objective To retrospectively analyze the results of operative treatment of displaced transverse acetabular fracture involving weight-bearing dome and relative factors affecting clinical results. Methods From May 1990 to July 2006, 37 patients with displaced transverse acetabular fracture involving weight-bearing dome were surgically treated, which included 26 males, 11 females, with the mean age of 34 years (range, 22-64 years). The patients were grouped as reduction quality, comminuted level of fracture, hip stability and cartilaginous damage of the femoral head. The clinical results were evaluated according to Mat-ta' reduction criterion, radiographic evaluation criterion, and modified Merle d'Aubigne and Postel clinical e-valuation standard. Results All the patients were followed up with an average 88.6 months (range, 16-121 months). The quality of reduction was graded as anatomical reduction in 31 patients, imperfect reduction in 4, unsatisfactory reduction in 2. Two hips were diagnosed as instability in X-ray. According to modified Mer-le d'Aubigne and Postel clinical evaluation standard, the clinical outcome was graded as excellent in 16 pa-tients (43.24%), good in 14 (37.84%), fair in 4 (10.81%), poor in 3(8.11%). The excellent and good rates in clinical outcome were 81.08%. The final Motto X-ray results were graded as excellent in 14 patients (37.84%), good in 15 (40.54%), fair in 4 (10.81%), poor in 4(10.81%). The excellent and good rates in X-ray results were 78.38%. There was a strong correlation between the clinical outcome and X-ray results. Ex-cellent and good rates in anatomical and nonanatomical reduction group were 90.32% and 33.33% respec-tively; Excellent and good rates in simple dome fracture and comminuted dome fracture group were 92.00% and 58.33% respectively; Excellent and good rates for hip instability and stability group were 0 and 85.71% respectively; Excellent and good rates in cartilaginous damage and non-cartilaginous damage of the femoral head group were 42.86% and 90.00% respectively. Conclusion Comminuted fracture of dome, poor frac-ture reduction, potential instability of hip, combined cartilaginous damage of the femoral head are risk factors influencing clinical outcome of displaced transverse acetabular fracture involving weight-bearing dome.