Mayo K A
Department of Orthopaedics, University of Washington, Seattle.
Clin Orthop Relat Res. 1994 Aug(305):31-7.
Management of displaced fractures of the acetabulum represents one of the greatest challenges in fracture surgery. This study reports intermediate term results for a single surgeon of 163 fractures in 161 patients treated by open reduction and internal fixation. The mean length of followup was 3.7 years. The most common fracture patterns treated were both column (67), transverse/posterior wall (32), posterior wall (14), and T shaped (12). The surgical approaches chosen were ilioinguinal (86), Kocher-Langenbeck (58), and extended iliofemoral (26) with 7 patients having sequential or simultaneous dual approaches. Reductions were rated by plain radiography and considered anatomic in 93 (56%) and near anatomic (< 2 mm displacement) in 40 (25%). There were 7 (4%) infections, 2 (1%) vascular injuries, 3 (2%) sciatic injuries, and 1 (1%) obturator nerve injury. Overall outcome was rated as excellent in 23 (14%), good in 101 (61%), fair in 25 (16%), and poor in 14 (9%). Nine patients have undergone hip salvage procedures. These results add to the growing body of clinical data which validates open reduction as the treatment of choice in most displaced fractures of the acetabulum.
髋臼移位骨折的治疗是骨折手术中最具挑战性的难题之一。本研究报告了一位外科医生采用切开复位内固定术治疗161例患者的163处骨折的中期结果。平均随访时间为3.7年。治疗的最常见骨折类型为双柱骨折（67例）、横形/后壁骨折（32例）、后壁骨折（14例）和T形骨折（12例）。所采用的手术入路为髂腹股沟入路（86例）、Kocher-Langenbeck入路（58例）和扩大髂股入路（26例），7例患者采用了序贯或同期双入路。通过X线平片对复位情况进行评估，93例（56%）为解剖复位，40例（25%）为近解剖复位（移位<2 mm）。发生感染7例（4%），血管损伤2例（1%），坐骨神经损伤3例（2%），闭孔神经损伤1例（1%）。总体结果评定为优23例（14%），良101例（61%），可25例（16%），差14例（9%）。9例患者接受了髋关节挽救手术。这些结果进一步丰富了临床数据，证实了切开复位是大多数髋臼移位骨折的首选治疗方法。
