摘要
目的探讨髋臼骨折的诊断和手术治疗方法与技巧,以提高髋臼骨折的诊疗水平。方法对32例移位髋臼骨折行术前CT平扫或三维重建确定骨折类型和制定手术方案,选择最佳手术入路进行骨折复位,以骨盆重建钢板和螺丝钉固定。结果32例全部获得6月-4年,平均15月的随访,按Maffa的疗效标准评定。临床标准:优26例、良3例、可3例。优良率87.8%,X线标准:优24例、良4例、可4例、优良率84.6%。并发症主要有坐骨神经损伤、股骨头坏死和异位骨化。结论CT三维重建对判断髋臼骨折的部位、移位方向和损伤程度具有重要意义,对手术入路选择和手术复位、固定具有指导作用。对于髋臼骨折的治疗应该采取更为积极的态度,只要移位大于2-3mm,都应切开复位内固定。术前正确判断骨折类型、选择最佳入路,术中准确复位和妥善固定是提高髋臼骨折疗效的关键。
Objective To discuss the diagnosis and operative treatme nt technology of acetabul ar fracture to improve the clinical treatment.Methods 32cases of displaced acetabular fra cture were reported.CT or 3-DCT were pe rformed before operative to understand the classification of the fracture and to determine the sch eme of operative.All cases were fixed by reconstruction pla tes and screws.Results32cases were all followed up for 6to 48months.Curat ive effect we re assessed by Maffa' s meathod.Clinical standard:26cases were ex-cellent,3cases were good,3cases we re acceptable.X ray standard:24c ases were excellent,4cases were good,4cases were acceptable.Main c omplicat ion were sciatic nerve inju ry,necrosis of fermoral head and het-erotopic ossi fication.Conclusion3-DCT is important to assess the site and displaced direct ion of fracture,also the degree of injury.It guides t he option of surgical ap proach and performance during operation.More active treatment should be perform e d with regard to acetabular fracture.If the displacement is greater than2-3mm,open reduction internal fixation should be exerted.Key point to enhance t he effect is to verdict the type of fracture,select the proper appro ach before operation and exert reduction and appropriate internal fixation during operatio n.
关键词
髋臼骨折
手术治疗
三维CT
Acetebular fracture Surgical treatment three-dimensional comp uted to mography
