Baumgaertel F
Klinik für Unfallchirurgie, Philipps-Universität Marburg/Lahn.
Orthopade. 1992 Nov;21(6):427-41.
Displaced acetabular fractures may lead to posttraumatic arthritis. Consequently, joint congruency must be restored by either conservative or operative measures. Standardized radiographs of the pelvis are prerequisites for the correct evaluation of the hip-joint. The a. p.-pelvis projection and the Judet views (obturator and iliac oblique) showing the whole pelvis are indispensable and demonstrate radiological landmarks typical of anatomical relationships and fracture characteristics. The two dimensional computertomogram is an adjunctive diagnostic measure and facilitates the evaluation of the hip joint itself. The 3DCT allows the imaging of old acetabular fractures and aids in the planning of reconstructive surgery. With the basic three projections of the hemipelvis, Letournel and Judet developed the acetabular fracture classification now accepted world-wide. Assuming the notion that the acetabulum is supported by two columns, five fracture types and five fracture type combinations are described according to involvement of the anterior or posterior columns respectively. The correct classification precedes the choice of surgical approach and is the basis for preoperative planning. The indications for surgery adhere to the principles of joint surgery. Conservative treatment may be considered only if the weight bearing joint surface of the acetabulum is congruent. Otherwise open reduction and internal fixation are indicated.
移位性髋臼骨折可能导致创伤后关节炎。因此，必须通过保守或手术措施恢复关节的一致性。骨盆的标准化X线片是正确评估髋关节的前提条件。前后位骨盆片以及显示整个骨盆的Judet位片（闭孔斜位和髂骨斜位）是必不可少的，它们能显示出典型解剖关系和骨折特征的放射学标志。二维计算机断层扫描是一种辅助诊断措施，有助于对髋关节本身进行评估。三维CT能够对陈旧性髋臼骨折进行成像，并有助于重建手术的规划。基于半骨盆的三个基本投影，勒图尔内和朱代特制定了目前被全球认可的髋臼骨折分类法。假定髋臼由两柱支撑这一概念，根据前柱或后柱的受累情况分别描述了五种骨折类型和五种骨折类型组合。正确的分类先于手术入路的选择，并且是术前规划的基础。手术指征遵循关节外科的原则。只有当髋臼的负重关节面一致时，才可以考虑保守治疗。否则，应进行切开复位内固定。
