髋臼骨折手术并发症的防治

目的探讨髋臼骨折手术并发症发生的原因及防治措施。方法总结我院1997年1月～2003年10月67例髋臼骨折手术治疗的病例，采用不同手术入路行手术切开复位内固定治疗，包括Kocher-Langenbeck入路44例，Ilio—inguinal入路12例，Extened Ilio—femoral入路5例，Ilio—femoral入路l例及联合入路5例。分析术后主要并发症的发生原因。结果平均随访36．4个月(6月～7年)，根据Matta临床标准和x线标准评定优良率分别为76．1％和73．1％。主要并发症为：坐骨神经损伤9例(13．4％)，异位骨化10例(14．9％)，股骨头缺血坏死3例(4．5％)，创伤性关节炎11例(16．4％)，经相应处理，疗效良好，无一例死亡，未再发生感染、血栓栓塞等并发症。结论髋臼骨折手术切开复位内固定疗效良好；术前正确判断骨折类型，选择最佳入路，术中减少手术创伤，良好复位和妥善固定，术后对症治疗可以减少并发症的发牛。

Prophylaxis and Treatment of Complications of Surgical Treatment for Acetabular Fracture

Objective To investigate the causes, prophyl ac tic method and treatment of complications of surgery for acetabular fracture. Methods 67 cases of acetabular fracture underwent interna l fixation via different approaches from January 1997 to October 2003, including Kocher-langenbeck approch in 44 cases, Ilio-inguinal approach in 12 cases, En tened Ilio-femoral approach in 5 cases, Ilio-femoral approach in 1 case and co mbined approach in 5 cases, were retrospectively reviewed with regard to the com plication causes. Results The excellent rates were 76.1% and 73.1% according to the Matta crite ria and X-ray standard respectively. The complications were treated prop erly and resulted in good prognosis without infection, death or thrombo- embdi, which included siatic nerve injury in 9 cases (13.4%),heterotopic ossific ation in 10 cases (14.9%), ischemic necrosis of femoral head in 3 cases (4.4%) a nd traumatic arthritis in 11 cases(16.4%). Conclusion With accurate judgement of fracture type and operation approac h, minimal intraoperative invasion, good reduction and fixation, the internal fi xation can demonstrate an excellent effectiveness in treating the acetabular fra cture.