复杂髋臼骨折的手术治疗

Surgical treatment of complex acetabular fractures

关键词:  髋臼骨折  手术  内固定

Key words:  acetabular fracture  operation  internal fixation

摘要:

［目的］ 总结移位复杂型髋臼骨折的手术治疗经验。［方法］ 1998年1月～2004年2月，共手术治疗32例，其中T形骨折8例，后柱伴后壁骨折4例，横行伴后壁骨折9例，双柱骨折10例，前柱伴后半横行骨折1例。手术采用Kocher-Langenbeck(K-L)入路13例，髂腹股沟入路11例，双入路（髂腹股沟＋K-L入路）8例。应用普通钢板螺钉及骨盆重建钢板螺钉进行骨折复位固定。［结果］ 30例获得随访，平均随访28个月（6～79个月），根据改良的Merle d′ Aubigne和Postel的髋臼骨折临床结果评分标准：优8例，良14例，一般6例，差2例，优良率为73.3%。［结论］ 移位复杂型髋臼骨折应尽早手术治疗，术前准确分析骨折类型，选择正确的手术入路，对骨折进行解剖复位，并采用有效内固定是提高手术疗效的关键。

Abstract:

［Objective］ To Summarize the surgical experiences of complex acetabular fractures. ［Methods］ Thirty-two cases of complex acetabular fractures were treated with open reduction and internal fixation from January 1998 to February 2004. Of the 32 cases, T-shaped fractures were seen in 8 cases, fractures of the posterior column and wall in 4, transverse and posterior wall in 9, both column in 10, anterior and hemi-transvers in 1 case. Kocher-Langenbeck approach was adopted in 13 cases, ilio-inguinal approach in 11 cases, doudle approaches (K-L＋ilio-inguinal) in 8 cases. Fractures were fixed with pelvic reconstract plates and screws. ［Results］ Thirty cases were followed-up for average 28 months (6～79 months). Excellent results were found in 8 cases, good in 14, fair in 6, and Poor in 2. The excellent and good rate was 73.3%. ［Conclusion］ Displaced complex acetabular fractures should be operated on time. Correct classification of fracture before operation, appropriate selection of operative approach, anatomical reduction, and strong internal fixation are key points to improve outcome of complex acetabular fracture.