髋臼骨折术后异位骨化的手术治疗

摘要

Objecfive To evaluate the clinical effeet of surgical resection of the severe heterotopic ossification(HO)after the open reduction intemal fixation(ORIF)of acetabular fractures.Methods Five cases of severe HO after the ORIF of acetabular fractures were treated by surgical resection from October 2005 to April 2007.All patients were male,the average age was 34 years(22 to 45 years).The average time of HO after ORIF of acetabular fractures was 14.2 months(3 to 30 months).The original surgical approachs were:Kocher-Langenbeck approach as 4,ilioinguinal combined K-L approach as 1.According to the Brooker classification,there were 4 patients with Ⅳ degree and 1 with Ⅲ degree.The average total movement for all the 5 patients was 8°.All patients received one time radiation therapy before or after operation,the dosage was 7-8 Gy.The surgical approach was Kocher-Langenbeck for all patients.During operatxon the nerve stimulator was used to explore the sciatic nerve and carefully protected it,resected all HO bone and removed all implants.For one patient,because of confusion between femoral head and acetabulum,total hip replacement were performed.The joint exercise(passively and actively)began from the second day after operation,and at the same time,all patients took the indomethacin to prevent the occurrence of HO.Results All patients were followed up for 4 to 22 months.There was no recuITence of HO,the average total movement for all the 5 patients was 160°.Conclusion Early surgical resection and combined with radiation and indomethacin for the severe HO after the ORIF of acetabular fractures can obtain excellent results.%目的 探讨髋臼骨折术后严重异位骨化手术切除松解的疗效.方法 2005年10月至2007年4月共收治髋臼骨折术后严重异位骨化患者5例,均为男性,平均年龄34岁(22～45岁).髋臼骨折手术后平均14.2个月(3～30个月)发生异位骨化.原始手术入路分别为:Kocher-Langenbeck入路4例,前后联合入路1例.根据Brooker分型,Ⅳ级4例,Ⅲ级1例.5例患者术前患髋活动范围平均为8°.所有患者手术前后均接受一次放射治疗,剂量为7～8 Gy.所有患者均取KoeherLangenbeck入路,术中使用神经探测仪探查并保护坐骨神经.完全切除异位骨化的骨组织,1例患者因股骨头和髋臼发生融合而行全髋关节置换.所有患者术后即开始无痛下功能锻炼,口服吲哚美辛预防异位骨化发生.结果 所有患者均获随访,平均随访时间8个月(4～22个月),伤口均Ⅰ期愈合,最终复查时均无异位骨化复发,患髋总活动范围平均为160°.结论 对于髋臼骨折术后严重异位骨化而导致髋关节活动障碍的患者,在骨折愈合后尽早手术切除,并配合药物和放射治疗可获得满意疗效.