移位复杂型髋臼骨折手术治疗26例

目的探讨移位复杂髋臼骨折的手术治疗方法和治疗效果。方法自2006年7月至2009年8月手术治疗移位复杂髋臼骨折26例,根据不同骨折类型,分别采用K-L入路9例、髂腹股沟入路6例和前后联合入路11例。结果术后复位情况按Matta标准评估：解剖复位17例,复位满意7例,复位不满意2例。术后随访6～36个月,按d＇Aubigne髋关节功能评价标准：关节功能优9例,良9例,可6例,差2例,优良率为69.2%。解剖复位组和非解剖复位组的优良率分别为88.2%和33.3%（P〈0.01）。结论开放复位内固定是移位复杂型髋臼骨折较好的治疗方法,术前明确骨折分型、合适入路、手术时机适当、解剖复位、牢固固定、早期功能锻炼是获得良好疗效的关键。

Operative Treatment of Displaced Complex Acetabular Fractures in 26 Cases

Objective To discuss the surgical techniques and results of displaced complex acetabular fractures.Methods Twenty-six cases of complex acetabular fracture with dislocation were treated with open reduction an internal fixation from July 2006 to August 2009.Kocher-Langenbeck approach（9 cases）,ilio-inguinal approach（6 cases） and double approachs（K-L ＋ ilio-inguinal）（11 cases） was adopted for different fractures.Results According to Matta criterion,seventeen cases had anatomic reduction,7 cases satisfactory reduction,2 cases unsatisfactory reduction.All cases were followed up for 6 ～ 36 months.According to d＇Aubigne evaluation,the results were excellent in 9,good in 9,fair in 6 and poor in 2.An excellent and good result was attained in 69.2%.Excellent and good rates for anatomic and non-anatomic reduction group were 88.2% and 33.3% respectively.The difference was very significant（P 0.01）.Conclusions Open reduction and internal fixation is reliable and effective for displaced complex acetabular fractures.Correct classification of fractures before operation,appropriate selection of operative approach,timely operation,satisfactory fracture reduction and reliable internal fixation and early functional rehabilitation are essential for reaching a good clinical result of complicated acetabular fractures.