CAJ | 학술논문

目的探讨陈旧性髋臼骨折的手术技术和影响临床效果的相关因素.方法 2001年4月至2008年12月,经手术治疗并有完整随访资料的陈旧性髋臼骨折患者61例.男47例,女14例;平均年龄(38±3)岁.按Letournel分型:简单型骨折16例中,后壁骨折7例,后柱骨折2例,前柱骨折1例,横行骨折6例;复合型骨折45例中,后柱伴后壁骨折3例,横行伴后壁骨折7例,"T"形骨折4例,伴后方半横行骨折6例,双柱骨折25例.交通伤52例,坠落伤6例,挤压伤3例.伴颅脑损伤11例,胸腹脏器损伤15例,膀胱尿道损伤7例,伴多处骨折25例,术前有坐骨神经损伤症状者3例.损伤至手术的平均时间39 d.选择单一手术入路13例,前后联合入路48例;手术平均耗时(248±45)min,术中平均失血(2160±100)ml.结果术后平均随访(61±8)个月.采用Matta的复位标准:解剖复位45例,不满意13例,差3例;根据改良Merle d'Aubingne和Postel临床结果评分:优38例,良13例,可6例,差4例.术后发生股骨头坏死3例(4.9%),异位骨化28例(45.9%),坐骨神经一过性麻痹4例(6.6%).结论对陈旧性髋臼骨折通过适当的切开复位内固定,也可达到满意的临床结果.对简单型陈旧性髋臼骨折可选择单一入路,而对于复合型骨折原则上采用前后联合入路.手术医生的经验与复位优良率密切相关.
목적 탐토진구성관구골절적수술기술화영향림상효과적상관인소.방법 2001년4월지2008년12월,경수술치료병유완정수방자료적진구성관구골절환자61례.남47례,녀14례;평균년령(38±3)세.안Letournel분형:간단형골절16례중,후벽골절7례,후주골절2례,전주골절1례,횡행골절6례;복합형골절45례중,후주반후벽골절3례,횡행반후벽골절7례,"T"형골절4례,반후방반횡행골절6례,쌍주골절25례.교통상52례,추락상6례,제압상3례.반로뇌손상11례,흉복장기손상15례,방광뇨도손상7례,반다처골절25례,술전유좌골신경손상증상자3례.손상지수술적평균시간39 d.선택단일수술입로13례,전후연합입로48례;수술평균모시(248±45)min,술중평균실혈(2160±100)ml.결과 술후평균수방(61±8)개월.채용Matta적복위표준:해부복위45례,불만의13례,차3례;근거개량Merle d'Aubingne화Postel림상결과평분:우38례,량13례,가6례,차4례.술후발생고골두배사3례(4.9%),이위골화28례(45.9%),좌골신경일과성마비4례(6.6%).결론 대진구성관구골절통과괄당적절개복위내고정,야가체도만의적림상결과.대간단형진구성관구골절가선택단일입로,이대우복합형골절원칙상채용전후연합입로.수술의생적경험여복위우량솔밀절상관.
Objective To discuss the surgical technique of delayed acetabular fractures and its possible prognosis factors.Methods From April 2001 to November 2008,61 patients with delayed acetabular fractures were surgically treated.There were 47 males and 14 males,with an average age of 38 years.According to Letourael classification,16 simple fractures included 7 cases of posterior wall fractures,2 of posterior column fractures,1 of anterior column fractures and 6 of transverse fractures.Forty-five patients with mixed fractures included 3 cases with both fractures posterior column and wall,7 of transverse and posterior wall fractures,4 of T-shape fractures,6 of posteriorly semi-transverse fractures and 25 of both-columns fractures.Fifty-two patients suffered from traffic accident;6 patients were caused by falling from height and 3 suffered from crush injuries.Brain injuries occurred in 11 cases,thorax-abdominal injuries in 15,urinary tract injuries in 7,multiple fractures in 25.The injury of sciatic nerve was found in 3 patients preoperatively.The average interval form injury to surgery was 39 days.A single approach was employed in 13 cases,and combined antero-posterior approaches were employed in 48.The operation time was (248±45) min with a blood loss of (2160±100) ml averagely.Results The average follow-up was (61±8) months.The clinical result was evaluated by Matta reduction criteria,modified Merle d'Aubingne and Postel scoring system.Anatomical reduction was achieved in 45 cases;however,13 were unsatisfactory and 3 were poor.For clinical results,38 were graded as excellent,13 as good,6 as fair and 4 as poor.Osteonecrosis of the femoral head occurred in 3 cases (4.9%),and heterotopic ossification developed in 28 cases (45.9%).Additionally,4patients (6.6%) had a transient sciatic nerve paralysis.Conclusion Open reduction and internal fixation is a liable method for delayed acetabular fractures.Single approach is suitable for simple fractures;in principle and combined approaches are for compound delayed acetabular fractures.The reduction quality is closely related to surgeon's experience.