87例髋臼骨折的手术治疗

目的探讨髋臼骨折手术治疗方法及效果。方法总结1999—2003年对87例有移位髋臼骨折进行手术治疗的经验。所有骨折均按Letournel—Judet的方法进行分型。根据不同骨折类型，分别采用Kocher—Langenbeck入路、髂腹股沟入路及前后联合入路进行骨折复位，以骨盆重建钢板和螺钉进行固定。结果87例患者平均随访时间28．5个月。根据Matta影像学评分，解剖复位52例，复位满意25例，复位不满意5例，差2例；3例关节轮廓复位。根据改良的Merled’Aubigne和Postel评分标准，优28例（32．2％），良41例（47．1％），一般12例（13．8％），差6例（6．9％）。发生股骨头坏死6例（6．9％），异位骨化18例（20．7％），创伤性关节炎12例（13．8％），无手术死亡、感染及骨折不愈合发生。结论及时手术、选择恰当的手术入路解剖复位、早期功能锻炼是提高髋臼骨折治疗效果的关键。

Operative treatment of acetabular fractures:a study of 87 cases

Objective To discuss the method for management of acetabular fractures and evaluate the corresponding results. Methods It was to summarize the experience in treatment of 87 cases of acetabular fractures treated operatively from 1999 to 2003, of which all fractures were classified according to the Letournel-Judet classification. Kocher-Langenbeck approach, illioinguinal approach and anterior combined posterior approach were adopted for different fractures with reconstruction plates and screws. Results All cases were followed up for average 28.5 months. According to criteria of Matta radiographic grade, there were 52 cases with anatomic reduction, 25 with satisfactory reduction, five with unsatisfactory reduction, two with poor reduction and three with joint contour reduction. Based on the modified Merle d' Aubigne and Postel clinical grading system, 28 cases (32.2%) showed excellent results, 41 (47.1%) good, 12 (13.8%) fair and six (6.9%) poor. Avascular necrosis of the femoral head was found in six cases (6.9%), heterotopic ossification in 18 cases (20.7%) and traumatic arthritis in 12 cases (13.8%). No death, infection or nonunion were found. Conclusion Operation on time, reasonable surgical approaches and anatomic reduction as well as early functional rehabilitation are essential to good treatment results of acetabular fractures.