Lü Chao-liang, Yue Fang, Yang Tian-fu, Wang Guang-lin, Lei Liu, Zhang Hui
Department of Orthopaedics, West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China.
Zhongguo Gu Shang. 2011 Aug;24(8):629-33.
To discuss the operative effects and evaluate how the waiting time before surgery influence the outcome of complex acetabular fractures.
From January 2006 to December 2008, 33 patients, 28 males and 5 females, with complex acetabular fractures were operated in our hospital. All of them were followed up for an average 24 months (ranged, 14 to 47 months). The average age was 42 years (ranged,27 to 57 years). According to the waiting time before surgery, all patients were divided into two groups, namely preoperative waiting time of more than 14 days group and preoperative waiting time of less than 14 days group. Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta radiological systems. The modified Merle d' Aubigne-postel hip scoring system was used for evaluating the functional outcomes. The Mos SF-36 was used to evaluate the quality of life.
Anatomical reduction in 28 cases, good in 4 cases, and poor in 1 case. According to the mean Merle d'Aubigne and Postel Score, 22 patients got excellent result, 4 good, 4 fair and 3 bad. Average score of the Mos SF-36 was (70.63 +/- 17.03). When time was measured as a categorical variable, an anatomical reduction and an excellent or good functional outcome were more likely if surgery was performed within 14 days. Postoperative complications: iatrogenic injuries of sciatic nerve in 2 cases, heterotopic ossification in 6 cases,traumatic osteoarthritis in 3 cases, and femoral head necrosis in 1 case.
Good image evaluation,correct approaches, appropriate time before surgery and approach, early functional rehabilitation are essential for better outcomes in the treatment of complex acetabular fractures, of which, time to surgery is a crucial and controllable prognostic factor.
探讨手术效果，并评估手术前等待时间如何影响复杂髋臼骨折的治疗结果。
2006年1月至2008年12月，我院对33例复杂髋臼骨折患者进行了手术，其中男性28例，女性5例。所有患者均获平均24个月（范围14至47个月）的随访。平均年龄42岁（范围27至57岁）。根据手术前等待时间，将所有患者分为两组，即术前等待时间超过14天组和术前等待时间少于14天组。根据Matta放射学系统评估术后复位质量和长期影像学结果。采用改良的Merle d'Aubigne-Postel髋关节评分系统评估功能结果。采用Mos SF-36评估生活质量。
解剖复位28例，良好4例，差1例。根据Merle d'Aubigne和Postel平均评分，22例患者结果为优，4例为良，4例为可，3例为差。Mos SF-36平均评分为（70.63±17.03）。当将时间作为分类变量时，如果在14天内进行手术，则更有可能实现解剖复位和优良的功能结果。术后并发症：坐骨神经医源性损伤2例，异位骨化6例，创伤性骨关节炎3例，股骨头坏死1例。
良好的影像学评估、正确的手术入路、合适的术前等待时间和手术方式、早期功能康复对于复杂髋臼骨折的良好治疗结果至关重要，其中手术时机是一个关键且可控的预后因素。
