髋臼骨折合并同侧下肢骨折临床治疗分析

目的：探讨髋臼骨折合并同侧下肢骨折的创伤机制和治疗方法。方法：髋臼骨折并同侧下肢骨折14例,男9例,女5例;年龄18～65岁,平均35岁。髋臼骨折按Letournel分型,后壁伴后柱骨折11例,单纯后柱骨折3例,均行钢板内固定。伴同侧股骨转子间骨折3例,1例行起重机架外固定,2例行DHS固定;伴同侧股骨颈骨折3例,均行空心钉加压固定;伴同侧股骨干骨折6例,1例行钢板固定,余5例行带锁髓内钉固定;伴同侧胫骨平台骨折2例,行钢板内固定。结果：1例半年后死亡,余13例获得随访,随访时间18个月～5年,平均30个月。按照美国矫形外科研究院髋关节疗效评定标准,优9例,良3例,差1例。结论：髋臼骨折合并同侧下肢骨折受伤暴力大、机制复杂、合并创伤多、易漏诊,应早期明确诊断,合理内固定。

Treatment of acetabulum fracture combined with ipsilateral lower extremity fracture

Objective: To discuss the treatment and mechanisim of acetabulum fracture combined with ipsilateral lower extremity fracture. Methods: Fourteen cases(9 males and 5 females) of acetabulum fracture were involved in the study with the mean age of 35 years (range,from 18 to 65 years). According to Letournel classification,11 cases were the fracture of posterior wall and column,3 cases were only the fracture of posterior column. All of them were treated with titanium plate internal fixation. Of three cases with ipsilateral femoral intertrochanteric fracture,one was treated with external fixiation device,other two were treated with DHS fixation;Three cases with ipsilateral femoral neck fracture were treated with compressive cannulated screw fixation;Among six cases with ipsilateral femoral shaft fracture,one was fixed with steel plate,the rest underwent intramedullary nailing fixation;Two cases with ipsilateral tibial plateau fracture were treated with anatomic plate internal fixation. Results: All patients except the died old patient were followed up from 18 months to 5 years,with mean of 30 months. According to standard of American institute of orthopaedics,9 cases obtained excellent results,3 good and 2 poor and the excellent and good rate was 92.3%. Conclusion: Most cases of acetabulum fracture combined with ipsilateral lower extremity fracture are due to great violence ,their mechanisms are complex ,and easily lead to missed diagnosis,therefore the early correct diagnosis,and reasonable internal fixation should be considered.