Opitz A, Vécsei V, Wagner M, Trojan E
Unfallchirurgie. 1982 Feb;8(1):14-26. doi: 10.1007/BF02585788.
The results of conservative and operative treatment of dislocated fractures of the acetabulum are compared. The types of fracture are described where surgical stabilisation is indicated. Depending of the type of fracture, the causes of unsatisfactory results following operative treatment are: primary lesions of the cartilage, difficulties with reduction and retention, septic complications. The aim of surgery is first of all the anatomic reconstruction of the supporting area of the acetabulum. 2/3 of our patients were operated between the 2nd and the 14th day. The lateral position with the extremity freely movable is recommended for dorsal and lateral approach. A trochanter traction screw with extension facilitates the operative reduction. It was possible to re-examine 45 of 64 cases after a period of between 2 and 13 years. Results were evaluated according to the scheme by Merle d'Aubigné. 35 patients had very good or good results, in 3 cases secondary arthrodesis was necessary and in one case a total hip prosthesis was implanted. Dislocated acetabular fractures should be be operated as soon as possible if conservative methods fail. Late reconstruction may also be successful. The lesion of the sciatic nerve is an absolute indication for operation. Satisfactory results can be achieved by anatomic reconstruction even in cases with multiple fragmentation.
对髋臼脱位骨折的保守治疗和手术治疗结果进行了比较。描述了需要手术稳定治疗的骨折类型。根据骨折类型，手术治疗后效果不理想的原因有：软骨原发性损伤、复位和固定困难、感染并发症。手术的首要目的是对髋臼支撑区域进行解剖重建。我们2/3的患者在第2天至第14天之间接受了手术。对于后路和外侧入路，建议采用肢体可自由活动的侧卧位。带延长装置的转子牵引螺钉有助于手术复位。在2至13年的时间段后，对64例中的45例进行了复查。根据Merle d'Aubigné的方案对结果进行评估。35例患者结果非常好或良好，3例需要二期关节融合术，1例植入了全髋关节假体。如果保守方法失败，髋臼脱位骨折应尽快进行手术。晚期重建也可能成功。坐骨神经损伤是手术的绝对指征。即使在骨折块较多的情况下，通过解剖重建也能取得满意的结果。
