摘要
目的探讨陈旧性髋臼骨折手术和影响临床结果的相关因素。方法2001年2月～2005年7月,收治陈旧性髋臼骨折37例,其中简单型骨折10例,复合型骨折27例。受伤至手术时间平均44.8d,选择Kocher-Langenbeck入路6例,髂腹沟入路1例,延长髂腹沟入路2例,前后联合入路28例。手术平均耗时226min,术中平均失血1798mL。结果全部患者平均随访18.9个月,采用Matta的复位标准以及改良的D’Aubigne和Postel临床结果评分。解剖复位31例,不满意4例,差2例;临床结果优21例,良9例,一般5例,差2例,优良率为81.1%。股骨头坏死1例,异位骨化11例,坐骨神经一过性麻痹4例。结论除单纯的后壁或/和后柱、前壁与前柱骨折选择单一的入路外,对于陈旧性髋臼骨折原则上采用前后联合入路或延长的髂腹沟入路;骨关节炎的发生与骨折的严重程度有关;股骨头坏死与术前股骨头是否向内或向后移位并无直接关系;临床结果、手术耗时和术中失血不仅与骨折程度和损伤至手术的时间有关,而且与手术医生的经验有关。
Objective To discuss the surgical treatment of delayed acetabular fractures and factors that affect the clinical outcomes. Methods From February 2001 to July 2005, 37 cases of delayed acetabular fractures were surgically treated. There were 22 males and 15 females, with an average age of 36.8 years （17 to 58）. 10 cases were simple fractures and 27 complicated ones. The interval between injury and surgery averaged 44.8 days （21 to 399 days） . 6 cases were treated through Kocher-Langenbeck approach, 1 ilio-inguinal approach, 2 extended ilio-inguinal approach, and 28 combined approaches. The mean operation time was 226 rain （120 to 490 min） . The average blood loss was 1 798 mL. Results The mean follow-up period was 18.9 months （6 to 56 months） . Evaluation was conducted with Matta＇s reduction criteria and modified D＇ Aubigne and Postel clinical scoring. Reduction was anatomical in 31 cases, unsatisfactory in 4 and poor in 2. Clinical outcomes were rated as excellent in 21, good in 9, fair in 5 and poor in 2. There was 1 case of femoral head necrosis. Heterotopic ossification developed in 11 cases. In addition, transient paralysis of the sciatic nerve happened in 4 patients. Conclusions In principle, combined or extended ilio-inguinal approach should be reserved for the delayed acetabular fractures with the exception of simple fractures of posterior wall or/and posterior column, anterior wall and anterior columu which can be managed by a single approach. The occurrence of arthritis correlates with the severity of the fracture. No direct relation has been found in this series between femoral head necrosis and femoral head dislocation before operation. Severity of fracture, interval between injury and surgery, and skills of orthopedists determine the clinical outcome, operation duration, and perioperative blood loss.
出处
《中华创伤骨科杂志》
CAS
CSCD
2005年第12期1117-1120,共4页
Chinese Journal of Orthopaedic Trauma
关键词
髋臼
骨折
陈旧性
手术
Acetabulum
Fracture,old
Surgery
