摘要
目的探讨手术治疗AOC型髋臼骨折的最佳手术时机和手术方法。方法自1999年2月～2004年1月共手术治疗AOC型(双柱)髋臼骨折46例,其中C1型23例,C2型14例,C3型9例。手术入路:髂腹股沟入路15例,改良Kocher-Langenbeck入路10例,前后联合入路21例。根据伤后距手术治疗的时间将46例患者分为3组:伤后第1周以内手术者15例(A组),第2周手术者23例(B组),第3周及以后者8例(C组);手术前、后均行X线片、CT三维重建检查,并通过X线片随访。结果46例患者中解剖复位34例(73.9%),复位欠佳者8例(17.4%),不满意复位4例(8.7%);随访12～36个月,平均31个月,采用D’Aubigne和Postel髋关节评分标准,功能表现优32例(69.6%),良5例(10.9%),可5例(10.9%),差4例(8.7%)。组间比较:复位程度A组与B组差异无显著性意义(P>0.05),A、B组与C组间差异有极显著性意义(P<0.01);复位程度与D’Aubigne和Postel髋关节功能评分密切相关(P<0.01)。髋关节功能A组与B组差异无显著性意义(P>0.05),但与C组差异有极显著性意义(P<0.01)。结论把各种影像学资料结合起来采用AO通用分型,能够全面了解骨折情况,正确诊断骨折类型;手术应尽可能在伤后2周内进行,并力求达到解剖复位。应用正确的复位和内固定方法是髋臼C型骨折取得良好疗效的关键。
Objective To discuss the timing and methods of operative treatment of acetabular fractures of AO Type C （double-column fractures）. Methods From February, 1999 to January, 2004, we treated operatively 46 cases of AO Type C acetabular fractures, including 23 cases of C-1 type, 14 cases of C-2 type, and 9 cases of C-3 type. 15 cases were treated through ilioinguinal approach, 10 cases through improved Kocher-Langenbeck approach, and 21 cases through combined anterior and posterior approaches. There were 3 groups of patients according to the time from injury to operation： 15 cases got operation within 1st week after injury （Group A）; 23 cases within 2nd week （Group B）; 8 cases within/after 3rd week （Group C）. All of them were checked with radiography and 3D CT scan before and after operation. Results 34 cases（73.9% ） obtained anatomical reduction, 8 cases（ 17.4% ） got imperfect reduction, and 4 cases（8.7% ） had unsatisfactory reduction. All the patients were followed up for 1 year to 4 years, averaging 31 months. According To D＇Aubigne and Postel Hip Score, joint function was rated as excellent in 32 cases（69.6% ）, good in 5 cases（ 10.9% ）, fair in 5 cases （10. 9% ） and poor in 4 cases （8.7%）. As far as reduction was concerned, there was a significant difference （ P 〈 0. 01 ） between Groups A and B and Group C, but no statistically significant difference between Group A and Group B （ P 〉 0. 05）. As far as joint function was concerned, there was a significant amelioration in Groups A and B compared with Group C （ P 〈 0. 01 ）, but no statistically significant difference could be found （ P 〉 0. 05） between group A and Group B. Conclusions Good knowledge of AO classification of acetabular fractures combined with particular radiological data can result in correct diagnosis of Type C acetabular fractures. Operations should be carried out within 2 weeks after injury and efforts should be made to ensure anatomical reduction. To achieve good clinical resu
出处
《中华创伤骨科杂志》
CAS
CSCD
2006年第2期108-111,共4页
Chinese Journal of Orthopaedic Trauma
关键词
髋臼
骨折
手术时机
手术方法
Acetabular
Fractures
Operative timing
Operative treatment
