摘要
目的探讨累及前、后柱的髋臼骨折的治疗方法。方法采用前侧髂腹股沟联合后侧的K-L入路切开复位,重建带或重建钢板内固定治疗25例累及前、后柱的髋臼骨折。记录手术时间、术中出血量、输血量,用Matta标准评价骨折复位程度。采用改良Harris髋关节评分标准和d′Aubigne-Postel标准评价髋关节功能。结果手术时间180～495(322.6±85.4)min,术中出血量400～5000(1402.0±908.4)ml,输血400～4000(1104.0±663.0)ml。其中9例采用自体血回输,输血量119～750(322.3±206.8)ml。根据Matta骨折复位标准:完全解剖复位23例,满意复位2例。24例得到12～61(32±15.8)个月随访。骨折均获得骨性愈合。Brooker Ⅲ型异位骨化和股骨头坏死各2例。改良Harris评分74～120(112.5±15.1)分。根据d′Aubigne-Postel标准:优16例,良4例,可3例,差1例。结论采用经髂腹股沟和髋关节后侧联合入路切开复位内固定治疗累及前后柱的髋臼骨折可获得良好效果。
Objective To explore the surgical treatment of the acetabular fractures involving anterior and posterior columns.Methods 25 cases of the acetabular fractures involving both the anterior and posterior columns were surgically treated with open reduction and internal fixation with reconstruction plate or reconstruction ribbons through a combined ilioinguinal and Kocher-Lengenbeck approach.The operating time,the volume of intra-operative blood loss and blood transfusions were recorded.The reduction was radiologically evaluated based on the criteria described by Matta.At the final follow-up,the patients were evaluated clinically according to the Modified Harris hip score and d＇Aubigne-Postel scoring system.Results The mean operating time of 25 cases was 322.6±85.4（180～495） minutes with a mean volume of 1402.0±908.4（400～5000） ml intraoperative blood loss.The mean volume of intraoperative blood transfusion was 1104.0±663.0（400～4000）ml.Autologous blood reinfusion was applied in 9 cases with a mean volume of 322.3±206.8（119～750）ml.Perfect and imperfect reductions were identified in 23 cases and 2 cases,respectively,without poor reductions.24 cases were followed up with mean time of 32±15.8（12～61） months leading to completely union of all the fractures.Brooker Ⅲ heterotopic ossification and avascualr necrosis of the femoral head occurred in 2 patients,respectively.The average Modified Harris hip score was 112.5±15.1（74～120） points.The outcomes were excellent in 16 cases,good in 4,fair in 3 and poor in 1 according to d＇Aubigne-Postel scoring system.Conclusions Good clinical results can be obtained when a combined ilioinguinal and Kocher-Lengenbeck approach is applied to reduce and stabilize the acetabular fractures involving both the posterior and anterior columns.
出处
《临床骨科杂志》
2010年第1期8-11,共4页
Journal of Clinical Orthopaedics
