河北医学
河北醫學
하북의학
HEBEI MEDICINE
2014年
9期
1438-1440
,共3页
髋关节%内固定%手术%栓桩%重建
髖關節%內固定%手術%栓樁%重建
관관절%내고정%수술%전장%중건
Hip joint%Internal fixation%Surgery%Bolt pile%Reconstruction
目的：探讨C型髋臼骨折严重粉碎骨软骨关节面的手术重建方法、可行性及疗效分析。方法：回顾总结2009年10月至2011年6月手术治疗严重髋臼粉碎性骨折23例23髋（ AO分型均为C型），均为C型髋臼骨折；选择髂腹股沟及髋臼后侧（ Kocher-langebeck ）联合入路。术中先纠正稳定且累及范围较广的髋臼周边部位骨折块，基本使头臼关系恢复，再采用可吸收螺钉、植骨、骨软骨折块镶嵌挤压等重建粉碎严重的髋臼关节面（碎裂软骨下骨及未游离的关节软骨），后用骨盆重建接骨板整体固定髋臼骨折部。术后根据稳定程度酌情给予矫形鞋或皮牵引制动4-6周，后床上进行静力肌肉舒缩功能锻炼及关节被动功能锻炼，术后3月渐进下地活动。结果：随访12个月至36月，平均16．6月。对位质量采用Matta标准：解剖复位21髋，不满意1髋，差1髋。临床结果评分依照改良Mered， Aubigne-Postel（3）：优21髋，良1髋，差1髋。术后股骨头坏死率（5．3％），异位骨化率（46．8％）。结论：首先通过复位髋关节外骨盆骨折及复位髋关节对位关系，其次借助可吸收螺钉、植骨、骨软骨折块间的镶嵌挤压等方法可完成C型髋臼骨折的重建，术后达到满意关节功能。
目的：探討C型髖臼骨摺嚴重粉碎骨軟骨關節麵的手術重建方法、可行性及療效分析。方法：迴顧總結2009年10月至2011年6月手術治療嚴重髖臼粉碎性骨摺23例23髖（ AO分型均為C型），均為C型髖臼骨摺；選擇髂腹股溝及髖臼後側（ Kocher-langebeck ）聯閤入路。術中先糾正穩定且纍及範圍較廣的髖臼週邊部位骨摺塊，基本使頭臼關繫恢複，再採用可吸收螺釘、植骨、骨軟骨摺塊鑲嵌擠壓等重建粉碎嚴重的髖臼關節麵（碎裂軟骨下骨及未遊離的關節軟骨），後用骨盆重建接骨闆整體固定髖臼骨摺部。術後根據穩定程度酌情給予矯形鞋或皮牽引製動4-6週，後床上進行靜力肌肉舒縮功能鍛煉及關節被動功能鍛煉，術後3月漸進下地活動。結果：隨訪12箇月至36月，平均16．6月。對位質量採用Matta標準：解剖複位21髖，不滿意1髖，差1髖。臨床結果評分依照改良Mered， Aubigne-Postel（3）：優21髖，良1髖，差1髖。術後股骨頭壞死率（5．3％），異位骨化率（46．8％）。結論：首先通過複位髖關節外骨盆骨摺及複位髖關節對位關繫，其次藉助可吸收螺釘、植骨、骨軟骨摺塊間的鑲嵌擠壓等方法可完成C型髖臼骨摺的重建，術後達到滿意關節功能。
목적：탐토C형관구골절엄중분쇄골연골관절면적수술중건방법、가행성급료효분석。방법：회고총결2009년10월지2011년6월수술치료엄중관구분쇄성골절23례23관（ AO분형균위C형），균위C형관구골절；선택가복고구급관구후측（ Kocher-langebeck ）연합입로。술중선규정은정차루급범위교엄적관구주변부위골절괴，기본사두구관계회복，재채용가흡수라정、식골、골연골절괴양감제압등중건분쇄엄중적관구관절면（쇄렬연골하골급미유리적관절연골），후용골분중건접골판정체고정관구골절부。술후근거은정정도작정급여교형혜혹피견인제동4-6주，후상상진행정력기육서축공능단련급관절피동공능단련，술후3월점진하지활동。결과：수방12개월지36월，평균16．6월。대위질량채용Matta표준：해부복위21관，불만의1관，차1관。림상결과평분의조개량Mered， Aubigne-Postel（3）：우21관，량1관，차1관。술후고골두배사솔（5．3％），이위골화솔（46．8％）。결론：수선통과복위관관절외골분골절급복위관관절대위관계，기차차조가흡수라정、식골、골연골절괴간적양감제압등방법가완성C형관구골절적중건，술후체도만의관절공능。
Objective:To study the surgery feasibility and curative effect of articular cartilage recon-struction in severe type C crushed fracture at acetabulum .Method: A retrospective analysis was conducted from the data of 23 cases operated for severe acetabulum comminuted fracture from October 2009 to June 2011, AO classification showed Type C fractures in all the 20 males and 3 females.Koaher-langenbeck and ilioinguinal approaches were adopted .A wide range of stable area surrounding the acetabulum fracture were removed at first , to recover the relationshipof head mortar positions .Absorbable screw fracture , bone graft , cartilages folded with bones were adopted to rebuild acetabulum joint surface , which was shattered seriously ( subchondral bone and free articular cartilage ) , pelvic bone reconstruction plate was used for fixation the whole acetabulum fractures .According to postoperative stability degree , orthopedic shoes or skin traction were applied for 4 to 6 weeks, followed by diastolic exercise of static muscles and passive joints activities ex-ercise in bed for 3 months, until advanced gradually .Result: The followed up lasted for 12 to 36 months, with an average of 16.6 months.Para quality using Matta standard showed 21 anatomical reduction , better in 1 case, and poor outcome with 1 case.Clinical outcome scores using improved Mered , Aubigne-Postel, (3) showed 21 cases recovered , mild score with 1 case and low score with 1 case , postoperative femoral head necrosis rate (5.3%), and heterotopic ossification rate (46.8%).Conclusion:Resetting hip pelvic fractures and hip para relationship , followed by using absorbable screws , soft bone graft , and interfolding with bones and cartilages can completely reconstruct type C of acetabulum fracture , achieving satisfactory joint function after surgery .
