复杂髋臼骨折手术治疗及疗效分析.docVIP

复杂髋臼骨折手术治疗及疗效分析 　 作者：滕范文，王淑和，冯运垒，郭奇峰 【摘要】 目的 总结复杂型髋臼骨折的治疗方法，探讨影响疗效的因素及提高疗效的方法。方法 对16 例16侧复杂型髋臼骨折，经髋臼正位片、髋臼闭孔斜位片、髂骨斜位片及CT三维重建明确分型后，分别采用KocherLangenbeck入路10 例，髂腹股沟入路2 例，王钢改良的髂股入路3 例，前后联合入路1 例，分别进行复位，应用重建钢板进行固定。对术后骨折复位质量和X线表现按Matta标准评估，髋关节功能按D′Aubigne和Postel 6分法标准评估。结果 随访3～36个月，优良率87.5％。术后发生创伤性关节炎2 例，异位骨化2 例，所有患者均骨愈合。结论 术前正确的骨折分型、手术入路的合理选择、术中良好的复位、简单有效的固定、预防并发症的发生以及手术时机的合理选择是提高髋臼骨折疗效的基础。 【关键词】 髋臼；复杂骨折；骨折固定术；治疗结果 The Surgical Therapy of Displaced Complex Acetabular Fractures and Analysis of the Factors of Influnenced Results Abstract： Objective To summarize the surgical therapy of displaced complex acetabular fractures， discuss the factors influenced results and the methods to improve effect. Methods After classification according to the three standard plain examinations and SSD in acetabular fractures， 16 cases of complex type of acetabular fracture with dislocation were treated with open reduction and internal fixation with reconstruction plates， KocherLangenbeck approach was adopted in 10 cases， ilioinguinal approach in 2 cases， Wanggang′s reformative iliofemoral approach in 3 cases， and anterior combined posterior approach in 1 case. We assessed the reduction quality with Matta radiographic grade and the function of hip joint with D′Aubigne and postel clinical grading system. Results All cases were followed up for 3～36 months， 12 cases had anatomic reduction， 2 cases satisfactory reduction， 1 case unsatisfactory reduction； And we only rebuilded the posterior wall for one case of old fracture in posterior column and posterior wall. The function of hip joint， 12 cases were excellent，2 good， 2 fair，and the rate of excellence and good was 87.5％. Traumatic arthritis was found in 2 cases， heterotopic ossification in 2 cases and all cases bone union. Conclusion According to our experience， accurate analysis of fractures preoperatively， reasonable surgical approaches， high reduction quality， effective fixation， precaution of complications and to hold right operation