Pavelka T, Kortus J, Linhart M, Matĕjka J
Klinika ortopedie a traumatologie pohybového ústrojí FN, Plzen.
Acta Chir Orthop Traumatol Cech. 2004;71(1):13-9.
The article presents a retrospective evaluation of a group of 119 patients treated for acetabular fractures between 1996 and 2002.
In the monitored period 119 patients, (89 men, 30 women) average age 35 years, were hospitalized with an acetabular fracture. Surgically treated were 91 patients (70 men, 21 women), average age 29 years. Prevailing in this group were Type A fractures which accounted for 45%, Type B was represented by 35% and Type C included 19%. Twenty-eight patients were treated conservatively.
Indication for surgical treatment was instability, hip incongruence or combination of both. Conservative treatment was chosen in the fractures without displacement, in fractures with secondary congruency and in case of contraindication of surgical treatment. The indication was always based on CT examination with a three-dimensional reconstruction. The surgery was performed within 24 hours in 42%, within 48 hours in 64%, within 72 hours in 87%. Posterior Kocher-Langenbeck approach was used in 54%, anterior ilioinguinal approach in 22% and the combination of both approaches in 24%. Posterior approach was indicated in A1, A2, B1 fractures, ilioinguinal approach in A3, B3, C1 Types, the combination of both approaches in B2, C2, C3 fractures. Osteosynthetic material was chosen according to the fracture type, bone quality and fragment size.
The evaluation was based on subjective complaints, radiograph and clinical examination using Harris Hip Score. In the group of 91 patients treated surgically we achieved excellent result in 41 cases (45%), very good result in 28 cases (31%), fair result in 7 cases (9%) and poor result in 13 cases (15%). We recorded 17 peroperative complications--11 times inadequate reduction, 5 times nerve injury, once vascular injury. Early complications included infect--twice and loosening of implant--once. Late complications occurred in 26 cases--paraarticular ossification in 17 cases, aseptic necrosis of the femoral head in 8 cases.
The treatment of fractures of the acetabulum as any intraarticular fracture is based on a precise anatomical reduction, stable fixation and early mobilization. Difficulties of the treatment of the acetabulum arise from the anatomical relations. Decisive for the indication, the method of treatment and prognosis is the type of the injury of the weight-bearing area of the acetabulum. In order to understand the type of the fracture it is necessary to make a careful preoperative examination based particularly on CT examination with a three-dimensional reconstruction. The indication and treatment strategy--surgical approach, method of reduction, type of fixation--is selected accordingly. Each surgical approach has its limits and also the possibilities of fixation are limited by the type of the fracture. The outcomes depend directly on the quality of the reconstruction of the articular surface and the incidence of complications, caused either by the injury or preoperatively.
The treatment of displaced fractures of the acetabulum is on principle surgical. Satisfactory results are produced only by anatomical reconstruction of the weight-bearing area of the acetabulum. Surgical treatment is highly demanding and the long-term results not always correspond to the efforts made.
本文对1996年至2002年间接受髋臼骨折治疗的119例患者进行回顾性评估。
在监测期内，119例患者（89例男性，30例女性）因髋臼骨折住院，平均年龄35岁。接受手术治疗的有91例患者（70例男性，21例女性），平均年龄29岁。该组中A型骨折占45%为主，B型占35%，C型占19%。28例患者接受保守治疗。
手术治疗的指征为不稳定、髋关节不匹配或两者兼有。对于无移位骨折、继发匹配的骨折以及手术治疗禁忌的情况，选择保守治疗。指征始终基于三维重建的CT检查。42%的手术在24小时内进行，64%在48小时内进行，87%在72小时内进行。54%采用后Kocher-Langenbeck入路，22%采用前髂腹股沟入路，24%采用两种入路联合。后入路适用于A1、A2、B1型骨折，髂腹股沟入路适用于A3、B3、C1型骨折，两种入路联合适用于B2、C2、C3型骨折。根据骨折类型、骨质和骨折块大小选择内固定材料。
评估基于主观症状、X线片以及使用Harris髋关节评分的临床检查。在91例接受手术治疗的患者中，41例（45%）获得优，28例（31%）获得良，7例（9%）获得可，13例（15%）获得差。记录了17例术中并发症——复位不佳11次，神经损伤5次，血管损伤1次。早期并发症包括感染2次和植入物松动1次。26例出现晚期并发症——关节周围骨化17例，股骨头无菌性坏死8例。
髋臼骨折的治疗与任何关节内骨折一样，基于精确的解剖复位、稳定固定和早期活动。髋臼骨折治疗的困难源于解剖关系。髋臼负重区损伤的类型对治疗指征、治疗方法和预后起决定性作用。为了解骨折类型，有必要进行仔细的术前检查，特别是基于三维重建的CT检查。相应地选择指征和治疗策略——手术入路、复位方法、固定类型。每种手术入路都有其局限性，固定的可能性也受骨折类型限制。结果直接取决于关节面重建的质量以及由损伤或术前因素引起的并发症发生率。
髋臼移位骨折的治疗原则上是手术治疗。只有髋臼负重区的解剖重建才能产生满意的结果。手术治疗要求很高，长期结果并不总是与付出的努力相符。
