Johnson E E, Matta J M, Mast J W, Letournel E
Department of Orthopaedic Surgery, University of California, Los Angeles 90024.
Clin Orthop Relat Res. 1994 Aug(305):20-30.
A retrospective review was performed of 207 patients treated by delayed reconstruction of acetabular fracture between 21 and 120 days following injury. Nineteen patients were lost to followup. One hundred eighty seven patients had 188 fractures classified as follows; 35 posterior wall, 9 posterior column, 5 anterior wall, 4 anterior column, 13 transverse, 49 transverse/posterior wall, 21 T shape, 8 posterior column/posterior wall, 8 anterior column posterior hemitransverse, and 34 both column fractures. The average preoperative delay was 43 days. Followup averaged 6.5 years (range, 9 months-30 years). Overall good to excellent results were achieved in 65% of patients, fair in 9%, and poor in 26%. Good to excellent results by fracture type were; posterior wall (51%), posterior column (89%), anterior wall (60%), anterior column (100%), transverse (69%), transverse/posterior wall (59%), T shape (62%), posterior column/posterior wall (88%), anterior column/posterior hemitransverse (75%), and both column (72%). Heterotopic ossification developed in 49 of 168 patients without prophylactic treatment, in 6 of 12 treated prophylactically with diphosphonate, and in 2 of 27 receiving prophylactic indomethacin therapy. There were 20 postoperative sciatic nerve palsies, 3 immediate and 5 delayed infections, 5 cases of pulmonary embolism, and 26 cases of avascular necrosis. Delayed management of acetabular fractures increases the difficulty of operative treatment and may result in a significant reduction in good to excellent results. Simple anterior or posterior wall fractures, associated transverse + posterior wall fractures, and T shape fractures have an increased risk of failure when treated within this time period.
对207例在受伤后21至120天接受髋臼骨折延迟重建治疗的患者进行了回顾性研究。19例患者失访。187例患者有188处骨折，分类如下：后壁35处，后柱9处，前壁5处，前柱4处，横行13处，横行/后壁49处，T形21处，后柱/后壁8处，前柱后半横行8处，双柱骨折34处。术前平均延迟时间为43天。随访平均6.5年（范围9个月至30年）。总体而言，65%的患者结果为良好至优秀，9%为一般，26%为较差。按骨折类型划分的良好至优秀结果为：后壁（51%），后柱（89%），前壁（60%），前柱（100%），横行（69%），横行/后壁（59%），T形（62%），后柱/后壁（88%），前柱/后半横行（75%），双柱（72%）。168例未接受预防性治疗的患者中有49例发生异位骨化，12例接受二膦酸盐预防性治疗的患者中有6例发生，27例接受预防性吲哚美辛治疗的患者中有2例发生。术后有20例坐骨神经麻痹，3例为即刻感染，5例为延迟感染，5例肺栓塞，26例缺血性坏死。髋臼骨折的延迟处理增加了手术治疗的难度，并可能导致良好至优秀结果显著减少。在此时间段内治疗简单的前壁或后壁骨折、合并的横行+后壁骨折以及T形骨折失败风险增加。
