Matta J M, Merritt P O
University of Southern California County General Hospital, Dept. of Orthopaedics, Los Angeles 90033.
Clin Orthop Relat Res. 1988 May(230):83-97.
Displaced acetabular fractures occur primarily in young adults involved in high energy trauma and can lead to disabling posttraumatic arthritis. An initial roentgenographic evaluation with accurate delineation of all fracture lines provides the key to decisions about whether to give closed or open treatment. When open treatment is indicated, a surgical approach can be chosen that will almost always lead to reduction without the necessity of a second approach. The authors have found that the Kocher-Langenbeck, ilioinguinal, and extended iliofemoral approaches are the most useful. A fracture table and specialized reduction instruments aid fracture reduction and fixation. Satisfactory operative reduction of the fracture is the factor that correlates best with a satisfactory clinical result. The rate of satisfactory operative reductions improved gradually over the first 50 operations of a prospective study of 121 displaced acetabular fractures. Overall, there were 80% satisfactory clinical results in this series. Complications included a 3% infection rate and a 5% incidence of nerve palsy. Open reduction and internal fixation are indicated for the majority of displaced fractures. However, closed treatment can produce satisfactory results in selected patients.
移位型髋臼骨折主要发生于遭受高能量创伤的年轻成年人，可导致创伤后致残性关节炎。最初的X线评估需准确描绘所有骨折线，这是决定采取闭合治疗还是开放治疗的关键。当需要开放治疗时，可选择一种几乎总能实现骨折复位且无需二次手术入路的手术方法。作者发现，Kocher-Langenbeck入路、髂腹股沟入路和扩大髂股入路最为实用。骨折手术台和专门的复位器械有助于骨折复位和固定。骨折的满意手术复位是与满意临床结果相关性最佳的因素。在前瞻性研究的121例移位型髋臼骨折的前50例手术中，满意手术复位率逐渐提高。总体而言，该系列的临床结果满意率为80%。并发症包括3%的感染率和5%的神经麻痹发生率。大多数移位骨折需行切开复位内固定术。然而，闭合治疗在部分患者中也可取得满意效果。
