常规髋臼手术入路联合大转子滑移截骨治疗复杂髋臼骨折疗效分析

摘要

目的 探讨采用常规髋臼手术入路联合大转子滑移截骨治疗复杂髋臼骨折的临床疗效.方法 回顾性分析自2010年1月至2014年12月沈阳军区总医院手术治疗的24例累及臼顶的复杂髋臼骨折患者的临床资料,依据Letournel-Judet分型分为横形加后壁骨折11例,后柱加后壁骨折6例,双柱骨折3例,T形骨折2例,前柱加后半横形2例.手术均采用常规髋臼手术入路联合大转子滑移截骨.采用Matta标准评估复位结果,以改良Merle d′Aubigne-Postel评分标准评价髋关节功能,利用美国医学研究委员会标准评估外展肌力情况.同时,记录患者术后并发症.结果 24例患者中,解剖复位16例,满意复位7例,不满意1例.髋臼骨折均获Ⅰ期骨愈合,所有大转子截骨均获骨性愈合.末次随访时的改良Merle d′Aubigne-Postel评分:优10例,良11例,可3例,优良率为87.5%(21/24).外展肌力评分:4级5例,5级19例.术后2例患者发生大转子内固定刺激症状,2例发生异位骨化,1例发生创伤性关节炎,1例发生股骨头缺血性坏死.结论 对于复杂髋臼骨折,尤其是累及臼顶的髋臼骨折,采用常规髋臼手术入路联合大转子滑移截骨可扩大手术显露视野,便于操作,可获得良好的骨折复位与功能恢复,并发症少,临床疗效满意.%Objective To investigate the clinical outcomes of sliding trochanteric osteotomy through conventional acetabular approaches in fixation of complicated acetabular fractures.Methods A retrospective study was performed on 24 cases of patients with complicated acetabular fractures who were admitted from January 2010 to December 2014.According to Letournel-Judet classication,there were 11 transverse associated with posterior wall fracture,6 posterior column and wall fractures,3 bicolumn fractures,2 T-shape fractures,2 anterior column and semi-transverse fractures All the fractures were reduced and fixed with sliding trochanteric osteotomy through conventional acetabular approaches.The standards of Matta,the modified Merled Aubigne-Postel,and Medical Research Council were respectively used to evaluate the reduction result,function of hip joint and the strength of hip abduction.Complications were recorded at follow-up.Results In all 24 patients,16 patients got anatomic reduction,7 got satisfied reduction,and 1 got unsatisfied result.All patients achieved primary bone union.At final follow-up,function of hip joint obtained excellent results in 10 cases,good in 11,and fair in 3,the excellent rate was 87.5%(21/24).The strength of the abductors of 19 patients were in Grade 5 and 5 patients were in Grade 4.Two patients sustained implants irritation in greater trochanter.Heterotopic ossification was found in 2 case,traumatic arthritis in 1 case,and ischemic necrosis of the femoral head in 1 case.Conclusion For complicated acetabular fractures,especially fractures involved acetabular dome,sliding trochanteric osteotomy through conventional acetabular approaches can provide an adequate exposure of the acetabular dome that would faciliate reduction and fixation,with low risk of complications and satisfactory clinical outcomes.