Milenković Sasa, Mitković Milorad, Saveski Jordan, Micić Ivan, Stojiljković Predrag, Stanojković Miodrag, Mitković Milan, Stamenić Sonja, Spalević Marija
Univerzitet u Nisu, Medicinski fakultet, Ortopedsko-traumatoloska Klinika KC Nis, Srbija.
Acta Chir Iugosl. 2013;60(2):65-9. doi: 10.2298/aci1302065m.
Acetabular fractures are severe injuries, mostly occured in young patients after traffic accident or fall from heights. Of the all acetabular fractures, posterior wall acetabular fractures are the most often observed. Regarding to mechanism of the injury, about 30% of these fractures are associated with posterior hip dislocation.
The incidence of AVN in 18 patients with posterior wall acetabular fractures associated with dislocations of the hip is presented. Thompson-Epstein Scale (type I-V) was used as the classification of the injury. Kocher-Langenbeck surgical approach was achieved in all patients.
Average following time after surgery was 22, 66 months (8-36 months). After that period the incidence of femoral head AVN was observed in 33.3%. Femoral head AVN was observed in 5.55% of patient who was treated by the reduction of hip dislocation in first 24 hours after injury, while in patients with later reduction, femoral head AVN were observed in 27.77%.
Posterior wall acetabular fractures associated with hip dislocation are severe injuries. Urgent, closed reduction of the hip, early definitive stable osteosynthesis of acetabulum and the experience of surgical team are factors that greatly decrease the possibility for AVN occurence. Later reduction, comminution of posterior wall of the acetabulum (Thompson- Epstein III et IV), impaction, chondral lesion of the femoral head and associated fractures of femoral head, increase the possibility for AVN occurence.
髋臼骨折是严重损伤，多发生于交通事故或高处坠落伤后的年轻患者。在所有髋臼骨折中，后壁髋臼骨折最为常见。就损伤机制而言，约30%的此类骨折伴有髋关节后脱位。
报告18例伴有髋关节脱位的后壁髋臼骨折患者的股骨头缺血性坏死（AVN）发生率。采用汤普森 - 爱泼斯坦量表（I - V型）对损伤进行分类。所有患者均采用 Kocher - Langenbeck 手术入路。
术后平均随访时间为22.66个月（8 - 36个月）。此后观察到股骨头AVN发生率为33.3%。伤后24小时内进行髋关节复位治疗的患者中，股骨头AVN发生率为5.55%，而复位较晚的患者中，股骨头AVN发生率为27.77%。
伴有髋关节脱位的后壁髋臼骨折是严重损伤。紧急闭合复位髋关节、早期对髋臼进行确切稳定的骨固定以及手术团队的经验是大大降低AVN发生可能性的因素。复位较晚、髋臼后壁粉碎（汤普森 - 爱泼斯坦III型和IV型）、股骨头嵌插、股骨头软骨损伤及股骨头相关骨折会增加AVN发生的可能性。
