CAJ | 학술논문

目的探讨手术治疗经顶型移位髋臼横形骨折的疗效及其影响因素.方法 1990年5月至2006年7月,手术治疗经顶型移位髋臼横形骨折37例,男26例,女11例;年龄22～64岁,平均34岁.根据复位质量、臼顶骨折粉碎程度、髋关节稳定性、股骨头软骨损伤等因素进行分组,按Matta术后X线复位标准和放射学评估标准及改良的Merle d'Aubigne和Postel功能评分标准进行评估.结果所有患者均获随访,随访时间16～121个月,平均88.6个月.术后解剖复位31例,复位欠佳4例,复位差2例.2例患者术后X线片示髋关节不稳.根据改良的Merle d'Aubigne和Postel功能评分,临床疗效:优16例(43.24%),良14例(37.84%),可4例(10.81%),差3例(8.11%),优良率为81.08%;远期随访MattaX线疗效:优14例(37.84%),良15例(40.54%),可4例(10.81%),差4(10.81%),优良率为78.38%.临床疗效与X线疗效存在相关性.临床优良率在解剖复位和非解剖复位组分别为90.32%和33.33%,在臼顶粉碎性骨折和非粉碎性骨折组分别为58.33%和92.00%,在髋关节不稳组和稳定组分别为0和85.71%,在股骨头软骨损伤和无软骨损伤组分别为42.86%和90.00%.结论骨折复位不佳、臼顶粉碎性旨折、髋关节不稳及股骨头软骨损伤等因素可直接影响经顶型移位髋臼横形骨折的手术疗效.
목적 탐토수술치료경정형이위관구횡형골절적료효급기영향인소.방법 1990년5월지2006년7월,수술치료경정형이위관구횡형골절37례,남26례,녀11례;년령22～64세,평균34세.근거복위질량、구정골절분쇄정도、관관절은정성、고골두연골손상등인소진행분조,안Matta술후X선복위표준화방사학평고표준급개량적Merle d'Aubigne화Postel공능평분표준진행평고.결과 소유환자균획수방,수방시간16～121개월,평균88.6개월.술후해부복위31례,복위흠가4례,복위차2례.2례환자술후X선편시관관절불은.근거개량적Merle d'Aubigne화Postel공능평분,림상료효:우16례(43.24%),량14례(37.84%),가4례(10.81%),차3례(8.11%),우량솔위81.08%;원기수방MattaX선료효:우14례(37.84%),량15례(40.54%),가4례(10.81%),차4(10.81%),우량솔위78.38%.림상료효여X선료효존재상관성.림상우량솔재해부복위화비해부복위조분별위90.32%화33.33%,재구정분쇄성골절화비분쇄성골절조분별위58.33%화92.00%,재관관절불은조화은정조분별위0화85.71%,재고골두연골손상화무연골손상조분별위42.86%화90.00%.결론 골절복위불가、구정분쇄성지절、관관절불은급고골두연골손상등인소가직접영향경정형이위관구횡형골절적수술료효.
Objective To retrospectively analyze the results of operative treatment of displaced transverse acetabular fracture involving weight-bearing dome and relative factors affecting clinical results. Methods From May 1990 to July 2006, 37 patients with displaced transverse acetabular fracture involving weight-bearing dome were surgically treated, which included 26 males, 11 females, with the mean age of 34 years (range, 22-64 years). The patients were grouped as reduction quality, comminuted level of fracture, hip stability and cartilaginous damage of the femoral head. The clinical results were evaluated according to Mat-ta' reduction criterion, radiographic evaluation criterion, and modified Merle d'Aubigne and Postel clinical e-valuation standard. Results All the patients were followed up with an average 88.6 months (range, 16-121 months). The quality of reduction was graded as anatomical reduction in 31 patients, imperfect reduction in 4, unsatisfactory reduction in 2. Two hips were diagnosed as instability in X-ray. According to modified Mer-le d'Aubigne and Postel clinical evaluation standard, the clinical outcome was graded as excellent in 16 pa-tients (43.24%), good in 14 (37.84%), fair in 4 (10.81%), poor in 3(8.11%). The excellent and good rates in clinical outcome were 81.08%. The final Motto X-ray results were graded as excellent in 14 patients (37.84%), good in 15 (40.54%), fair in 4 (10.81%), poor in 4(10.81%). The excellent and good rates in X-ray results were 78.38%. There was a strong correlation between the clinical outcome and X-ray results. Ex-cellent and good rates in anatomical and nonanatomical reduction group were 90.32% and 33.33% respec-tively; Excellent and good rates in simple dome fracture and comminuted dome fracture group were 92.00% and 58.33% respectively; Excellent and good rates for hip instability and stability group were 0 and 85.71% respectively; Excellent and good rates in cartilaginous damage and non-cartilaginous damage of the femoral head group were 42.86% and 90.00% respectively. Conclusion Comminuted fracture of dome, poor frac-ture reduction, potential instability of hip, combined cartilaginous damage of the femoral head are risk factors influencing clinical outcome of displaced transverse acetabular fracture involving weight-bearing dome.