中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2009年
12期
1101-1104
,共4页
孙玉强%梁吉华%陈圣宝%唐明杰%曾炳芳
孫玉彊%樑吉華%陳聖寶%唐明傑%曾炳芳
손옥강%량길화%진골보%당명걸%증병방
髋臼%骨折%手术%骨化%异位性%相关因素
髖臼%骨摺%手術%骨化%異位性%相關因素
관구%골절%수술%골화%이위성%상관인소
Acetabulum%Fracture%Surgery%Ossification%heterotopic%Correlated factors
目的 探讨髋臼双柱骨折术后并发异位骨化(H0)的影响因素.方法 自2001年4月至2006年12月,采用手术治疗并获得随访的193例髋臼双柱骨折患者中,男147例,女46例,平均年龄34.4岁;合并颅脑外伤31例.损伤1周内手术者15例,1～2周者121例,2～3周者34例,超过3周者23例.回顾性对手术方法、伴发损伤、伤后延迟手术时间等因素进行分析,探讨其对髋臼舣柱骨折术后HO形成的影响.结果 手术平均耗时238 min(150～330 min),术中平均出血1453 mL(450～4400 mL).平均随访44.2个月(14～84个月),HO发生率为39.9%(77/193),其中Ⅰ度39例,Ⅱ度23例,Ⅲ度15例,手术时间与HO严重程度无显著相关(R=0.207,P=0.071).其中颅脑外伤组14例,非颅脑外伤组63例,两组HO的发生率差异无统计学意义(χ~2=0.019,P=0.891);伤后不同时期内手术后HO发生情况分别为:1周内2例,1～2周者38例,2～3周者21例,大于3周者16例,延迟不同手术时间的HO发生率差异有统计学意义(χ~2=21.89,P<0.05);HO分级与疗效无显著相关(R=0.041,P=0.722).手术切口中清除坏死的臀小肌后,仅15例(7.8%)发牛严重的HO.结论 髋臼双柱骨折术后HO的形成与是否伴有颅腩外伤无显著相关,与延迟手术时间高度相关,清除坏死臀小肌和手术区域其他坏死肌肉可以减少术后HO的形成.
目的 探討髖臼雙柱骨摺術後併髮異位骨化(H0)的影響因素.方法 自2001年4月至2006年12月,採用手術治療併穫得隨訪的193例髖臼雙柱骨摺患者中,男147例,女46例,平均年齡34.4歲;閤併顱腦外傷31例.損傷1週內手術者15例,1～2週者121例,2～3週者34例,超過3週者23例.迴顧性對手術方法、伴髮損傷、傷後延遲手術時間等因素進行分析,探討其對髖臼艤柱骨摺術後HO形成的影響.結果 手術平均耗時238 min(150～330 min),術中平均齣血1453 mL(450～4400 mL).平均隨訪44.2箇月(14～84箇月),HO髮生率為39.9%(77/193),其中Ⅰ度39例,Ⅱ度23例,Ⅲ度15例,手術時間與HO嚴重程度無顯著相關(R=0.207,P=0.071).其中顱腦外傷組14例,非顱腦外傷組63例,兩組HO的髮生率差異無統計學意義(χ~2=0.019,P=0.891);傷後不同時期內手術後HO髮生情況分彆為:1週內2例,1～2週者38例,2～3週者21例,大于3週者16例,延遲不同手術時間的HO髮生率差異有統計學意義(χ~2=21.89,P<0.05);HO分級與療效無顯著相關(R=0.041,P=0.722).手術切口中清除壞死的臀小肌後,僅15例(7.8%)髮牛嚴重的HO.結論 髖臼雙柱骨摺術後HO的形成與是否伴有顱腩外傷無顯著相關,與延遲手術時間高度相關,清除壞死臀小肌和手術區域其他壞死肌肉可以減少術後HO的形成.
목적 탐토관구쌍주골절술후병발이위골화(H0)적영향인소.방법 자2001년4월지2006년12월,채용수술치료병획득수방적193례관구쌍주골절환자중,남147례,녀46례,평균년령34.4세;합병로뇌외상31례.손상1주내수술자15례,1～2주자121례,2～3주자34례,초과3주자23례.회고성대수술방법、반발손상、상후연지수술시간등인소진행분석,탐토기대관구의주골절술후HO형성적영향.결과 수술평균모시238 min(150～330 min),술중평균출혈1453 mL(450～4400 mL).평균수방44.2개월(14～84개월),HO발생솔위39.9%(77/193),기중Ⅰ도39례,Ⅱ도23례,Ⅲ도15례,수술시간여HO엄중정도무현저상관(R=0.207,P=0.071).기중로뇌외상조14례,비로뇌외상조63례,량조HO적발생솔차이무통계학의의(χ~2=0.019,P=0.891);상후불동시기내수술후HO발생정황분별위:1주내2례,1～2주자38례,2～3주자21례,대우3주자16례,연지불동수술시간적HO발생솔차이유통계학의의(χ~2=21.89,P<0.05);HO분급여료효무현저상관(R=0.041,P=0.722).수술절구중청제배사적둔소기후,부15례(7.8%)발우엄중적HO.결론 관구쌍주골절술후HO적형성여시부반유로남외상무현저상관,여연지수술시간고도상관,청제배사둔소기화수술구역기타배사기육가이감소술후HO적형성.
Objective To discuss factors influencing the heterotopic ossifications (HO) after treatment of bi-column acetabular fractures. Methods One hundred and ninety-three cases of bi-column acetabular fractures were followed up, including 147 males and 46 females with an average age of 34. 4 years. Thirty-one cases were associated with craniocerebral trauma. The interval between injury and surgery was less than 1 week in 15 cases, 1 to 2 weeks in 121 cases, 2 to 3 weeks in 34 cases, and over 3 weeks in 23 cases. Factors that might have influenced HO, including surgical method, associated injury, and interval between injury and surgery, were analyzed retrospectively. Results All the cases were followed up for an average of 44. 2 (14 to 84) months. The mean operation time was 238 (150 to 330) minutes, and the average blood loss was 1453 (450 to 4400) mL. The incidence rate of HO was 39. 9% (77 in 193 cases), including 39 cases of degree one, 23 cases of degree two, and 15 cases of degree three. Of the 77 cases associated with HO, 14 had craniocerebral trauma and 63 did not (χ~2 = 0. 019, P = 0. 891) . HO was found in 2 cases that had been operated on in less than 1 week, 38 cases in 1 to 2 weeks, 21 cases in 2 to 3 weeks, and 16 cases in over 3 weeks. The Spearman correlation analysis between HO degree and clinical result showed no correlation ( R = 0. 041, P =0. 722). Only 15 cases (7. 8% ) were associated with HO after the debridement of the necrotic gluteus minimus. Conclusions HO after surgery for bi-column acetabular fractures may not be correlated with craniocerebral trauma, but highly correlated with the interval between injury and surgery. Debridement of necrotic gluteus minimus and other muscles can reduce the incidence of HO.
