复杂髋臼骨折的手术治疗及疗效分析

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1、复杂髋臼骨折的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Postel6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

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TheSurgicalTherapyofDisplacedComplexAcetabularFracturesandAnalysisoftheFactorsofInflunencedResultsAbstract：ObjectiveTosummarizethesurgicaltherapyof10displacedcomplexacetabul

3、arfractures，discussthefactorsinfluencedresultsandthemethodstoimproveeffect.MethodsAfterclassificationaccordingtothethreestandardplainexaminationsandSSDinacetabularfractures，16casesofcomplextypeofacetabularfracturewithdislocationweretreatedwithopenreductionandinternalfixationwithrecon

4、structionplates，KocherLangenbeckapproachwasadoptedin10cases，ilioinguinalapproachin2cases，Wanggang′sreformativeiliofemoralapproachin3cases，andanteriorcombinedposteriorapproachin1case.WeassessedthereductionqualitywithMattaradiographicgradeandthefunctionofhipjointwithD′Aubigneandposte

5、lclinicalgradingsystem.ResultsAllcaseswerefollowedupfor3～36months，12caseshadanatomicreduction，2casessatisfactoryreduction，1caseunsatisfactoryreduction；Andweonlyrebuildedtheposteriorwallforonecaseofoldfractureinposteriorcolumnandposteriorwall.Thefunctionofhipjoint，12caseswereexcellent

6、，2good，2fair，andtherateofexcellenceandgoodwas87.5％.Traumaticarthritiswasfoundin2cases，heterotopicossificationin2casesandallcasesboneunion.ConclusionAccordingtoourexperience，accurateanalysisoffracturespreoperatively，reasonablesurgical10approaches，highreductionquality，effectivefixation

7、，precautionofcomplicationsandtoholdrightoperationtimeareessentialtogoodtreatmentofacetabularfractures.Keywords：acetabulum；complexfractures；fracturefixation；treatmentoutcome复杂型髋臼骨折(complexacetabularfractures，CAF)是严重而复杂的关节内骨折，由于髋臼解剖部位深，解剖结构复杂，手术复位困难，并发症发生率高，加之髋臼复杂骨折多为高能量损伤，大多合并多脏器损伤及多发

8、骨折，因此移位复杂型髋臼