经手术治疗的经腔横断髋臼骨折的结果。
Results after surgical treatment of transtectal transverse acetabular fractures.
机构信息
Department of Orthopaedic Surgery, The First Affiliated Hospital of Suzhou University, Suzhou, China.
出版信息
Orthop Surg. 2010 Feb;2(1):7-13. doi: 10.1111/j.1757-7861.2009.00056.x.
OBJECTIVE
To retrospectively evaluate the results of operative treatment of transtectal transverse fractures of the acetabulum.
METHODS
From May 1990 to July 2006, 40 patients with displaced transtectal transverse fracture of the acetabulum were treated surgically. A mean postoperative follow-up of 88.6 months' (range, 16-121 months) was achieved in 37 patients. Final clinical results were evaluated by a modified Merle d'Aubigné and Postel grading system. Postoperative radiographic results were evaluated by the Matta criteria. Fracture and radiographic variables were analyzed to identify possible associations with clinical outcome.
RESULTS
Fracture reduction was graded as anatomic in 31 patients, imperfect in 4 and unsatisfactory in 2. Two hips were diagnosed to have subtle instability by postoperative radiography. The clinical outcome was graded as excellent in 16 patients, good in 14, fair in 4 and poor in 3. The radiographic result was graded as excellent in 14 patients, good in 15, fair in 4 and poor in 4. There was a strong association between the final clinical and radiographic outcomes. Variables identified as risk factors for unsatisfactory results included residual displacement greater than 2 mm, comminuted fracture of the weight bearing dome, postoperative subtle hip instability and damage to the cartilage of the femoral head.
CONCLUSION
The uncomplicated radiographic appearance of transtectal transverse fracture belies its complexity. Comminuted fracture of the weight bearing dome, unsatisfactory fracture reduction, subtle hip instability and damage to the cartilage of the femoral head are risk factors for the clinical outcome of transtectal transverse fracture of the acetabulum.
目的
回顾性评估经横突切开治疗髋臼横形骨折的疗效。
方法
1990 年 5 月至 2006 年 7 月，对 40 例移位性髋臼横形骨折患者进行手术治疗。37 例患者获得平均 88.6 个月（16-121 个月）的术后随访。采用改良的 Merle d'Aubigné 和 Postel 评分系统评估最终临床结果，采用 Matta 标准评估术后影像学结果。分析骨折和影像学变量，以确定与临床结果相关的因素。
结果
31 例患者的骨折复位被评为解剖复位，4 例为不完美复位，2 例为不满意复位。术后影像学检查诊断 2 髋存在轻微不稳定。临床结果评为优 16 例，良 14 例，可 4 例，差 3 例。影像学结果评为优 14 例，良 15 例，可 4 例，差 4 例。最终临床和影像学结果之间存在很强的相关性。被确定为不满意结果的危险因素包括残余移位>2mm、负重区粉碎性骨折、术后髋关节轻微不稳定和股骨头软骨损伤。
结论
经横突切开治疗髋臼横形骨折看似简单，但实际上较为复杂。负重区粉碎性骨折、复位不满意、髋关节轻微不稳定和股骨头软骨损伤是髋臼横形骨折临床结果的危险因素。
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