CAJ | 학술논문

目的探讨常规髋臼手术入路加大转子截骨治疗复杂髋臼]骨折的疗效方法 2006年1月至2009年12月共收治13例复杂髋臼骨折患者,男10例,女3例；年龄21 ～52岁,平均39.3岁；骨折根据Letournel-Judet分型:双柱骨折10例,T形骨折2例,前方+后方半横断骨折1例.受伤至手术时间为8～18d,平均12.1d.所有患者均采用常规髋臼手术入路(Kocher-Langenbeck入路或Kocher-Langenbeck加髂腹股沟联合入路)加大转子截骨治疗.术后采用改良Merle d'Aubigné和Postel 评分标准评定患者疗效,同时记录患者术后并发症的发生情况. 结果 13例患者术后获平均26个月(14 ～34个月)随访.骨折复位质量:解剖复位5例,良好复位7例,不满意复位(髋臼顶存在压缩骨折)1例.大转子截骨均愈合良好.根据改良Merle d'Aubigné和Postel评分标准评定患者疗效:优4例,良5例,中4例,优良率为69.2％.3例(23.1％)患者发生异位骨化,3例(23 1％)患者发生创伤性关节炎.无感染及股骨头缺血性坏死等并发症发生. 结论髋臼前方+后方半横断骨折、T形骨折及双柱累及髋臼顶的骨折可通过在常规入路中加用大转子截骨治疗,手术显露好且有利于复位和固定,术后患者功能恢复良好.
목적 탐토상규관구수술입로가대전자절골치료복잡관구]골절적료효 방법 2006년1월지2009년12월공수치13례복잡관구골절환자,남10례,녀3례；년령21 ～52세,평균39.3세；골절근거Letournel-Judet분형:쌍주골절10례,T형골절2례,전방+후방반횡단골절1례.수상지수술시간위8～18d,평균12.1d.소유환자균채용상규관구수술입로(Kocher-Langenbeck입로혹Kocher-Langenbeck가가복고구연합입로)가대전자절골치료.술후채용개량Merle d'Aubigné화Postel 평분표준평정환자료효,동시기록환자술후병발증적발생정황. 결과 13례환자술후획평균26개월(14 ～34개월)수방.골절복위질량:해부복위5례,량호복위7례,불만의복위(관구정존재압축골절)1례.대전자절골균유합량호.근거개량Merle d'Aubigné화Postel평분표준평정환자료효:우4례,량5례,중4례,우량솔위69.2％.3례(23.1％)환자발생이위골화,3례(23 1％)환자발생창상성관절염.무감염급고골두결혈성배사등병발증발생. 결론 관구전방+후방반횡단골절、T형골절급쌍주루급관구정적골절가통과재상규입로중가용대전자절골치료,수술현로호차유리우복위화고정,술후환자공능회복량호.
Objective To evaluate the efficacy of great trochanterie osteotomy through conventional acetabular approaches in treatment of complicated acetabular fractures. Methods From January 2006 to December 2009,13 acetabular fractures were treated in our department.They were 10 men and 3 women,21to 52 years of age (average,39.3 years).According to Letournel-Judet classification,there werc 10 cases of double column fracture,2 cases of T-shaped fracture and one case of anterior-posterior semi-transverse fracture.The mean time from injury to surgery was 12.1 days (from 8 to 18 days).They wcre treated with great trochanteric osteotomy through conventional acetabular approaches (Kocher-Langenbeck or Kocher-Langenbeck plus ilioinguinal approaches).Modified Merle d'Aubigné and Postel evaluation system was used to assess functional recovery,and complications were recorded at the follow-up. Results All cases were followed up for an average duration of 26 months (from 14 to 34 months).Five cases obtaiued anatomic reduction,7good reduction and one poor reduction (compression fracture at the acetabular top).All fractures healed.Four cases were rated as excellent,5 as good and 4 as fair,with an excellent to good rate of 69.2％.Heterotopic ossification was found in 3 cases (23.1％) and traumatic arthritis in 3 cases (23.1％).Neither infection nor ischemic necrosis of the femoral head was recorded. Conclusion Complicated acetabular fractures,like T-shape,double column,anterior column plus posterior semi-transverse,and transverse plus posterior wall ones,can be treated by great trochanteric osteotomy through conventional approaches,because this surgical strategy can provide fine operative exposure which facilitates reduction and fixation.