Shrestha D, Dhoju D, Shrestha R, Sharma V
Department of Orthopaedic and Truamtology Dhulikhel Hospital, Kathmandu University Hospital Dhulikhel, Kavre.
Kathmandu Univ Med J (KUMJ). 2014 Oct-Dec;12(48):279-87. doi: 10.3126/kumj.v12i4.13735.
With the development of better imaging modalities including 3D CT scan and availability of technical expertise, operative management is increasingly performed for acetabular fracture but many patients in developing countries like Nepal, are still being treated with prolonged skeletal traction.
To analyses epidemiology, types of acetabular fracture and functional and radiological outcome of patients with acetabular fracture treated with open reduction and internal fixation (ORIF).
Inpatients hospital records of patients treated with ORIF in between June 2007 to June 2014 were evaluated. Patient's demographic data, mode of injury, injury hospital interval, injury surgery interval, associated injuries, surgical approach, total hospital stay and peri and post-operative complications were recorded and radiological and functional outcomes were evaluated.
Thirty three patients (Male: 24 Female: 9) with average age 39 years (range: 21 to 65 years) were operated for acetabular fracture. Twenty one patients (63%) had injury related with motor vehicle accidents and nine (24%) of them had motorbike accidents. Injury hospital interval ranges from 7 to 36 days. Average injury-surgery interval was 21 days and average hospital stay was 22 days. Bicolumnar fractures were found in 15. Nine patients had dislocation of hip and 15 had concomitant other injuries. Biculumanr fixation was performed in 15 patients, posterior column and or wall in nine with Kocher Langenbeck approach and anterior column and or wall in other nine with ilio-inguinal approach. Radiological reduction was anatomical in 18; excellent/good functional outcome was in 26 and radiological outcomes were excellent in 14. Three patients had developed Hypertopic ossification. Follow up period ranged from 6 to 48 months and 15 patients (45%) had follow up >2 years.
Acetabular fractur can be effectively managed with ORIF and have predictable and comparable functional and radiographic outcomes. Upgrading the existing facilities and training of orthopedic surgeon for acetabular fracture management is important to shorten injury-surgery interval due to lack of such facilities.
随着包括三维CT扫描在内的更好的成像方式的发展以及技术专长的具备，髋臼骨折的手术治疗越来越多，但在尼泊尔等发展中国家，许多患者仍接受长时间的骨牵引治疗。
分析接受切开复位内固定术（ORIF）治疗的髋臼骨折患者的流行病学、髋臼骨折类型以及功能和影像学结果。
评估2007年6月至2014年6月间接受ORIF治疗的患者的住院病历。记录患者的人口统计学数据、受伤方式、受伤至入院间隔、受伤至手术间隔、合并伤、手术入路、总住院时间以及围手术期和术后并发症，并评估影像学和功能结果。
33例髋臼骨折患者接受了手术（男性24例，女性9例），平均年龄39岁（范围：21至65岁）。21例（63%）患者的损伤与机动车事故有关，其中9例（24%）为摩托车事故。受伤至入院间隔为7至36天。平均受伤至手术间隔为21天，平均住院时间为22天。发现15例双柱骨折。9例患者髋关节脱位，15例合并其他损伤。15例患者采用双柱固定，9例采用Kocher-Langenbeck入路进行后柱和/或后壁固定，另外9例采用髂腹股沟入路进行前柱和/或前壁固定。18例患者影像学复位达到解剖复位；26例患者功能结果为优/良，14例患者影像学结果为优。3例患者发生异位骨化。随访时间为6至48个月，15例患者（45%）随访时间超过2年。
切开复位内固定术可有效治疗髋臼骨折，并具有可预测且可比的功能和影像学结果。由于缺乏相关设施，升级现有设施并培训骨科医生进行髋臼骨折治疗对于缩短受伤至手术间隔很重要。
