Cai Leyi, Lou Yiting, Guo Xiaoshan, Wang Jianshun
Department of Orthopaedics Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, NO.109, XueYuan West Road, Luheng District, Wenzhou, Zhejiang, 325000, People's Republic of China.
Int Orthop. 2017 Sep;41(9):1803-1811. doi: 10.1007/s00264-017-3532-0. Epub 2017 Jun 14.
To explore the diagnosis, treatment, and clinical prognosis of patients with both unstable pelvic fractures and concomitant acetabular fractures.
We retrospectively analyzed 21 cases of unstable pelvic fractures with concomitant acetabular fractures treated between January 2013 and December 2014. All 21 patients (18 males, 3 females), aged 43.5-55 years (range: 21-55 years), underwent surgery within four to 15 days (average = 6.5 days) after injury. We evaluated the pre-operative diagnoses, surgical approaches, types of fixation used, and prognoses.
All 21 patients were followed-up for six to 18 months. The quality of post-operative pelvic fracture reduction (determined using the Matta scoring criteria) was excellent in five cases, good in 12, and fair in four. The clinical outcomes at the final follow-up (scored using the Majeed criteria) were excellent in ten cases, good in eight, and fair in three. The quality of post-operative acetabular fracture reduction (determined using the Matta scoring criteria) was excellent in five cases, good in 11, and poor in five. Hip joint function was evaluated at the final follow-up (using the D'Aubigné scoring system) and was excellent in eight cases, good in nine, and fair in four. The healing time was 12-18 weeks for pelvic fractures and 12-22 weeks for acetabular fractures. Post-operative wound infections in two patients were controlled after second operations featuring debridement and irrigation. We found no instance of heterotopic ossification, ischemic necrosis of the femoral head, or iatrogenic vascular or nerve injury.
Good therapeutic outcomes in patients with unstable pelvic fractures and concomitant acetabular fractures can be achieved via accurate diagnosis, careful pre-operative planning, a well-performed operation, effective reduction and surgical fixation, and appropriate exercise to allow functional rehabilitation.
探讨不稳定骨盆骨折合并髋臼骨折患者的诊断、治疗及临床预后。
回顾性分析2013年1月至2014年12月间收治的21例不稳定骨盆骨折合并髋臼骨折患者。所有21例患者（男18例，女3例），年龄43.5 - 55岁（范围：21 - 55岁），于受伤后4至15天（平均6.5天）内行手术治疗。我们评估了术前诊断、手术入路、所用固定类型及预后情况。
21例患者均获随访6至18个月。术后骨盆骨折复位质量（采用Matta评分标准判定）：优5例，良12例，可4例。末次随访时临床疗效（采用Majeed标准评分）：优10例，良8例，可3例。术后髋臼骨折复位质量（采用Matta评分标准判定）：优5例，良11例，差5例。末次随访时髋关节功能（采用D'Aubigné评分系统评估）：优8例，良9例，可4例。骨盆骨折愈合时间为12至18周，髋臼骨折愈合时间为12至22周。2例患者术后伤口感染，经二次手术清创冲洗后得到控制。未发现异位骨化、股骨头缺血坏死或医源性血管神经损伤病例。
不稳定骨盆骨折合并髋臼骨折患者，通过准确诊断、精心术前规划、良好手术操作、有效复位及手术固定，以及适当锻炼促进功能康复，可取得良好治疗效果。
