重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折

摘要

Objective To explore the clinical effect of operation fixation in hip dislocation with acetabular posterior wall fracture and the influencing factors on prognosis.Methods 35 cases diagnosed as hip dislocation with acetabular posterior wall fracture were treated with reconstruction plate internal fixation through K-L approach.Results 35 cases were followed up for 2 years ～ 5 years and 4 months.Modified Merle d'Aubingne-Postel scoring system was used for clinical assessing:excellent in 16 cases,good in 12,fair in 4,and poor in 3.Matta imaging ratings:excellent in 13 cases,good in 16,fair in5,and poor in 1.Clinical results and X-ray ratings was significantly positive correlation.The patients with age ≥55y or the reduction time ≥12h or complex type fracture showed a significant decrease in the clinical scoring.Conclusions Instantaneous diagnosis and reduction,restoration of acetabular continuity and stability are the keys of successful treatment.Patient age,reduction time and fracture type are important factors for the prognosis.%目的 探讨重建钢板内固定治疗髋关节后脱位伴髋臼后壁骨折的临床疗效及影响预后的相关因素.方法 对35例髋关节后脱位伴髋臼后壁骨折的患者采用K-L入路、AO重建钢板内固定治疗.结果 35例均获随访,时间2年～5年4个月.采用改良Merle d'Aubingne-Postel评分系统评价:优16例,良12例,一般4例,差3例.Matta影像学分级:优13例,好16例,一般5例,差1例.临床结果与X线分级呈显著正相关.患者年龄≥55岁、复位时间≥12 h及复杂性骨折患者中临床评分明显降低.结论 对于髋关节后脱位伴髋臼后壁骨折,及时确诊和满意复位、恢复髋臼的连续性和稳定性是取得满意手术疗效的关键；患者年龄、复位时间、骨折类型是影响患者预后的重要因素.