大转子后半截骨术在累及臼顶的髋臼骨折中的应用

目的：介绍一种新的大转子截骨方法，并评估后外侧入路联合该方法治疗累及髋臼顶部骨折的治疗效果。方法：2008年3月至2010年11月，采用髋关节后外侧入路联合大转子后半截骨治疗累及臼顶的髋臼骨折30例，其中男21例，女9例；年龄18—70岁，平均35．2岁。按照Letournel—Judet分型：后壁骨折10例，后柱骨折7例，横形骨折5例，T形骨折2例，横形伴后壁骨折1例，后柱伴后壁骨折3例，双柱骨折2例。根据Matta标准评估复位结果，改良的Merled＇Aubigne—Postel评分标准评定髋关节功能及美国医学研究委员会标准评定标准评估外展肌力。结果：所有患者获得随访，时间18—40个月，平均25个月。所有截骨获骨性愈合，平均愈合时间为8．4周（6-12周）。无骨不连、截骨块近端移位、内固定松动、断裂及深部感染等并发症发生。根据Matta标准：解剖复位17例，满意复位12例，不满意1例。末次随访时髋关节功能结果优11例，良15例，可3例，差1例。外展肌力4级3例，5级27例。结论：大转子后半截骨术可以增加臼顶部手术视野，有效提高股骨头与髋臼的解剖对应率，降低复位和固定难度，并发症少，为累及髋臼顸的骨折治疗提供了新思路。

Posterior partial trochanteric osteotomy for the treatment of the roof involved acetabular fractures

Objective: To introduce a new trochanteric osteotomy,and evaluate the outcome of the procedure combined a posterior lateral approach in treating acetabular fractures which involving the roof. Methods: Between March 2007 and Novmber 2010,30 patients with displaced acetabular fractures involving the dome need trochanteric osteotomy were retrospectively reviewed. There were 21 males and 9 females,ranging in age from 18 to 70 years with an average of 35.2 years at the time of injury. According to Letournel-Judet classification,there were 10 posterior wall fractures,7 posterior column fractures,5 transverse fractures,2 T-shape fractures,1 transverse associated with posterior wall fracture,3 posterior column and wall fractures and 2 bicolumn fractures. The standards of Matta,the modified Merle d'Aubigne-Postel,Medical Research Council were respectively used to evaluate the reduction result,function of hip joint and the strength of hip abduction. Results: All patients were followed up with an average time of 25 months (18 to 40) and all osteotomy sites obtained bone union with an average time of 8.4 weeks (6 to 12). No bone non-union,bone block displaceing,internal fixation looseing and breaking,infection of deep part were found. Seventeen patients got anatomic reduction,12 got satisfied reduction,and 1 got unsatisfied result according to the criteria of Matta. At final follow-up,function of hip joint obtained excellent results in 11 cases,good in 15,fair in 3 and poor in 1. The strength of the abductors of 3 patients were grade 4 and 27 patients were grade 5. Conclusion: Posterior partial great trochanteric osteotomy can enhance the exposure and provide a more accurate reduction and degrade the difficulty of acetabular fracture fixation without increasing the risk of complications. The method provide a new way for the treatment of the roof involved acetabular fractures.