髋臼骨折的手术治疗探讨_医学论文.docVIP

髋臼骨折的手术治疗探讨_医学论文 髋臼骨折的手术治疗探讨_医学论文 作者：姬广林　 徐房添　吴东保　何澄　赖光松　刘午阳　温煦　黄为民 【摘要】 　　［目的］探讨髋臼骨折手术治疗的入路、方法及效果。［方法］总结2000年２月～2005年１２月对34例有移位髋臼骨折手术治疗的经验。其中男22例，女12例；年龄16～61岁，平均39岁。术前根据X线片及CT检查结果,所有骨折均按Letournel的方法进行分型,简单型骨折13例，复合型骨折21例。根据不同骨折类型，分别采用Kocher入路23例、髂腹股沟入路6例及前后联合入路5例进行复位，以骨盆重建钢板螺钉进行固定。手术平均耗时2.5 h,术中平均失血0.6 L。［结果］所有患者术后随访时间12～64个月,平均31个月。根据Matta 影像学评分，解剖复位18例，复位满意9例，复位不满意3例，4例关节轮廓复位。根据改良的Merle D Aubigne和Postel评分标准，关节功能优11例，良15例，一般4例，差4例,优良率为76.5%。解剖复位加满意复位的临床优良率为85.2%，而差及关节轮廓复位的优良率为42.9%(0.05)。X线片结果按Epstein标准评价,优10例，良17例，一般3例，差4例，优良率为79.4%。术后发生股骨头坏死2例异位骨化3例,其中BrookerⅠ°1例，Ⅱ°2例创伤性关节炎3例，无手术死亡、感染及骨折不愈合发生。［结论］术前完善的影像学资料、正确的骨折分型、及时手术、恰当的手术入路、解剖复位、牢固固定、早期功能锻炼是提高治疗效果的关键。 【关键词】 骨折髋臼 分型 手术入路 骨折固定术 　　Operative treatment of acetabular fractures 　　Abstract：［Objective］To discuss the method for operative treatment of acetabular fractures and assess corresponding results.［Method］Totally 34 cases of acetabular fractures treated operatively from February 2000 to　December 2005 were reviewed. There were 22 males and 12 females, with an average age of 39 years (16 to 61).On the basis of Xray and computed tomography,all fractures were classified according to the LetournelJudet classification,13 cases were simple fractures and 21 complicated ones. KocherLangenbeck approach(23 cases)，illioinguinal approach(6 cases) and anterior combined posterior approach(5 cases) were adopted for different fractures with reconstruction plates and screws.The mean operation time was 150 min.The average blood loss was 600 mL.［Result］All cases were followed up for average 31 months(12 to 64 months).According to the criteria of Matta radiographicgrade，there were 18 cases with anatomic reduction， 9 with satisfactory reduction，3 with unsatisfactory reduction and 4 with joint contour reduction.Based on the modified Merle D Aubigne and Postel clinical grading system for joint functions,11 cases（32.4%）showed excellent results，15（44.1%）good，4（11.8%）fair and 4（11.8%）poor. The excellent and good rate for anatomic an