Webb L X, Bosse M J, Mayo K A, Lange R H, Miller M E, Swiontkowski M F
Department of Orthopedic Surgery, Wake Forest University Medical Center, Winston-Salem, North Carolina.
J Orthop Trauma. 1990;4(4):376-82.
Results in 23 patients with significant craniocerebral trauma (Glasgow Coma Scale less than or equal to 10) and displaced acetabular fracture requiring surgery were reviewed after a minimum follow-up of 1 year. Despite a postoperative anatomic reduction in all but one case, clinical outcome for these hips was poor, with an average Harris hip rating of 59. Patients older than 40 years had a significantly poorer outcome than did younger patients (p = 0.004). Postoperative problems occurred in 70% of patients (n = 16); the largest portion of these represented symptomatic heterotopic bone, which occurred in 61%. None of the four patients who had an anterior ilioinguinal surgical approach had symptomatic heterotopic ossification. The average Glasgow outcome score was 3.9 out of 5, and 20 of the 23 patients, despite a prolonged convalescence, were able to return to independence and self-care. The authors conclude that patients with combined significant craniocerebral trauma and an operatively managed displaced acetabular fracture are likely to have compromised hip function despite a well-executed osteosynthesis. This was especially true for those patients over age 40 in this series. The authors suggest that if the fracture pattern permits it, the operative management of the acetabular fracture in these patients be by an anterior ilioinguinal approach, so as to minimize the formation of heterotopic bone.
对23例伴有严重颅脑创伤（格拉斯哥昏迷量表评分小于或等于10分）且髋臼骨折移位需要手术治疗的患者进行了回顾性研究，这些患者至少随访了1年。尽管除1例患者外所有患者术后均实现了解剖复位，但这些髋关节的临床结果较差，Harris髋关节平均评分为59分。40岁以上患者的结果明显比年轻患者差（p = 0.004）。70%的患者（n = 16）出现了术后问题；其中最大部分为有症状的异位骨，占61%。采用髂腹股沟前入路手术的4例患者均未出现有症状的异位骨化。格拉斯哥结局评分平均为3.9分（满分5分），23例患者中有20例尽管康复期延长，但仍能够恢复独立生活和自我护理能力。作者得出结论，尽管进行了良好的接骨术，但伴有严重颅脑创伤且髋臼骨折移位需手术治疗的患者髋关节功能可能受损。在本系列中，40岁以上的患者尤其如此。作者建议，如果骨折类型允许，这些患者髋臼骨折的手术治疗应采用髂腹股沟前入路，以尽量减少异位骨的形成。
