髋臼骨折手术治疗临床探讨.docVIP

髋臼骨折手术治疗临床探讨 　　【摘要】 目的 对髋臼骨折手术治疗治疗进行临床分析。方法 对53例髋臼骨折患者，根据骨折移位程度、骨折类型、伤后时间等因素，41例在硬膜外麻醉下手术，12例在全麻下手术，分别选择不同的内固定材料进行手术。结果 经随访3～36个月，术后无一例发生切口感染、坐骨神经、血管损伤、深静脉栓塞、股骨头坏死及关节周围骨化。骨折均愈合，愈合时间6~13周。结果评定：优20例，良26例，可4例，差3例，优良率86.8%。结论 手术治疗髋臼骨折是有效方法，值得临床推广应用。? 　　【关键词】髋臼骨折；骨折固定术 　　? 　　Clinical study of the effect of acetabulum fracture Surgery HUANG Biao, ZHANG Hong, LONG Feng，qiang.Department of Orthopedics Wuhua People?s Hospital, Meizhou,Meizhou 529500,China 　　【Abstract】 Objective clinical analysis of the effect of surgery for acetabulum fractures. Methods 53 cases of patients with acetabular fracture were selected to observe.According to the degree of displacement fracture, fracture type and injury time, 41 cases were in surgery with epidural anesthesia and the others with general anesthesia. Different fixation materials were chosen. Results After 3 to 36 months? follow，up, postoperative wound infection, injury of sciatic nerve and vascular, deep vein embolism, femoral head necrosis and periarticular ossification had not occured. All fractures healed with the healing time from 6 weeks to 13 weeks. Evaluation of results: excellent in 20 cases, good in 26 cases, moderate in 4 cases, and poor in 3 cases.The rate of good healing was 86.8%. Conclusion Operative treatment of acetabular fractures is an effective way, which is worthy of clinical application.? 　　【Key words】Acetabular fractures; Fracture fixation 　　? 　　髋臼骨折是髋关节较为严重的损伤， 类型复杂，合并伤多，且是一种负重关节内的骨折，常常导致残废和创伤性关节炎，治疗较为困难［1］。如治疗不当，常导致创伤性关节炎、股骨头坏死的发生。手术治疗髋臼骨折由于其疗效好，卧床时间明显缩短，后遗关节功能障碍减少等优点，已为大多数骨科医师所接受。我们采用切开复位内固定方法对53例髋臼骨折患者进行治疗，收到了较好的效果，现报告如下。? 　　1 资料与方法? 　　1.1 一般资料 53例髋臼骨折患者，男31例，女22例，年龄18～66岁，平均35.8岁。右髋24例，左髋29例。受伤原因：交通事故伤36例，高处坠落伤13例，砸压伤4例。合并失血性休克20例，股骨头后脱位7例，中心性脱位3例，坐骨神经损伤6例，骨盆骨折4例，股骨干骨折5例，胫腓骨骨折5例，脊柱骨折8例，合并胸腔或腹部脏器损伤9例，脑外伤6例。合并颅脑外伤、胸腔或腹腔脏器损伤者均于相关科室及时处理后转骨科治疗。根据Letournel和Judet标准骨折分类，前柱骨折14例，后壁骨折16例，双柱骨折6例，横形+后壁骨折4例，后柱骨折6例，前柱+后壁骨折4例，后柱+后壁骨折3例。所有患者均行骨盆正斜位检查，其中28例行CT扫描，25例行三维CT重建。? 　　1.2 治疗方法? 　　1.2.1 并发症的处理 伴失血性休克者，行抗