Dong Changchao, Wu Gang, Wang Guanglin, Yang Tianfu, Fang Yue, Liu Lei, Xue Jianli
Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Apr;23(4):430-4.
To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors.
From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accident in 40 cases, falling from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker-Lagenbach approach was used in 23 cases, anterior ilioinguinal approach was applied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases.
Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external iliac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn't collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled'Aubigné-Postel hip score system. Patients' quality of life was compared with local population norms matched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vitality, role limitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, quality of fracture reduction and traumatic arthritis were independent risk factors affecting postoperative functional outcomes.
Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, quality of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.
评估复杂髋臼骨折的手术治疗效果并探讨其影响因素。
2000年6月至2006年8月，对54例复杂髋臼骨折患者进行治疗，其中男性44例，女性10例，年龄20 - 75岁（平均39.1岁）。骨折原因：交通事故40例，高处坠落8例，重物挤压6例。所有病例均为新鲜闭合性骨折，伤后至手术时间为5 - 72天。其中后壁和后柱骨折5例，横形和后壁骨折25例，T形骨折2例，双柱骨折22例。手术中，采用Kocker - Lagenbach入路23例，髂腹股沟前入路3例，前后联合入路28例。所有病例均采用AO重建钢板及螺钉内固定。
52例获得随访，随访时间12 - 74个月（平均31.3个月）。解剖复位23例，满意复位19例，复位不佳10例，优良率达80.77%。术中1例髂外静脉撕裂，经静脉修复后愈合；2例坐骨神经损伤，口服甲钴胺，其中1例完全恢复，另1例随访18个月时恢复不完全。末次随访时，重度异位骨化6例，其中1例行异位骨切除，其余5例保守治疗；创伤性骨关节炎9例，其中1例行全髋关节置换，其余8例保守治疗；股骨头缺血性坏死5例，其中2例行全髋关节置换，1例因股骨头未塌陷未进一步治疗，其余2例放弃全髋关节置换；根据改良Merled'Aubigné - Postel髋关节评分系统，75.00%的患者评定为优良。采用SF - 36量表将患者生活质量与年龄、性别匹配的当地人群标准进行比较，其总分低于当地人群标准，其总体健康、活力、因情绪问题导致的角色受限及心理健康与当地人群标准相当。Logistic回归分析显示，髋关节脱位复位时间、骨折复位质量及创伤性关节炎是影响术后功能结局的独立危险因素。
切开复位内固定治疗移位复杂髋臼骨折具有满意的治疗效果。髋关节脱位复位时间、骨折复位质量以及创伤性关节炎是影响术后功能结局的独立危险因素。
