中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2014年
6期
486-489,513
,共5页
王志刚%屈铁男%崔书豪%陈洪瑜
王誌剛%屈鐵男%崔書豪%陳洪瑜
왕지강%굴철남%최서호%진홍유
髋臼骨折%内固定治疗%髋关节功能%影响因素
髖臼骨摺%內固定治療%髖關節功能%影響因素
관구골절%내고정치료%관관절공능%영향인소
Acetabulum fracture%Internal fixation%Hip joint function%Influential factors
背景：髋臼骨折多为高能量损伤所致，属于关节内骨折，手术是最佳治疗方式。但骨折类型、手术入路、复位质量、年龄、手术时机等会对治疗效果产生影响。因此，分析影响手术效果的关键因素十分必要。<br> 目的：探讨手术治疗髋臼骨折后影响髋关节功能恢复的因素。<br> 方法：选择2010年1月至2013年10月手术治疗且随访资料完整的髋臼骨折患者42例，18例采用Kocher-Langenbeck入路，14例采用髂腹股沟入路，10例采用前后联合入路。术后采用Matta标准评定骨折复位情况。采用改良的Merled' Aubigne-Postel评分系统评价患者髋关节功能。对可能影响手术疗效的指标（如性别、年龄、手术时机、骨折类型、手术入路、复位质量等）进行单因素及多因素Logistic回归分析，筛查影响手术疗效的危险因素。<br> 结果：术后14例达到解剖复位，20例良好复位，8例一般复位。切口均甲级愈合，未出现感染。全部患者术后随访12~26个月，平均19个月。X线检查示骨折于术后10~18周愈合，平均14周。术后出现坐骨神经损伤4例，创伤性关节炎2例，股骨头缺血坏死2例，异位骨化7例。术后6个月时髋关节功能评定为优13例，良21例，可5例，差3例，优良率为81%。单因素分析结果显示性别、年龄、手术入路、髋关节脱位与手术疗效无明显关系（P＞0.05），而手术时机、骨折类型、复位质量、异位骨化与手术疗效有关（P＜0.05）。多因素分析显示骨折类型、手术时机、复位质量是影响手术效果的独立因素（P＜0.05）。<br> 结论：骨折类型、手术时机和复位质量是影响髋臼骨折手术疗效的独立因素，而后两者是相对可控的因素，治疗时要选择合适时机、尽量达到解剖复位，以期获得良好的临床结局。
揹景：髖臼骨摺多為高能量損傷所緻，屬于關節內骨摺，手術是最佳治療方式。但骨摺類型、手術入路、複位質量、年齡、手術時機等會對治療效果產生影響。因此，分析影響手術效果的關鍵因素十分必要。<br> 目的：探討手術治療髖臼骨摺後影響髖關節功能恢複的因素。<br> 方法：選擇2010年1月至2013年10月手術治療且隨訪資料完整的髖臼骨摺患者42例，18例採用Kocher-Langenbeck入路，14例採用髂腹股溝入路，10例採用前後聯閤入路。術後採用Matta標準評定骨摺複位情況。採用改良的Merled' Aubigne-Postel評分繫統評價患者髖關節功能。對可能影響手術療效的指標（如性彆、年齡、手術時機、骨摺類型、手術入路、複位質量等）進行單因素及多因素Logistic迴歸分析，篩查影響手術療效的危險因素。<br> 結果：術後14例達到解剖複位，20例良好複位，8例一般複位。切口均甲級愈閤，未齣現感染。全部患者術後隨訪12~26箇月，平均19箇月。X線檢查示骨摺于術後10~18週愈閤，平均14週。術後齣現坐骨神經損傷4例，創傷性關節炎2例，股骨頭缺血壞死2例，異位骨化7例。術後6箇月時髖關節功能評定為優13例，良21例，可5例，差3例，優良率為81%。單因素分析結果顯示性彆、年齡、手術入路、髖關節脫位與手術療效無明顯關繫（P＞0.05），而手術時機、骨摺類型、複位質量、異位骨化與手術療效有關（P＜0.05）。多因素分析顯示骨摺類型、手術時機、複位質量是影響手術效果的獨立因素（P＜0.05）。<br> 結論：骨摺類型、手術時機和複位質量是影響髖臼骨摺手術療效的獨立因素，而後兩者是相對可控的因素，治療時要選擇閤適時機、儘量達到解剖複位，以期穫得良好的臨床結跼。
배경：관구골절다위고능량손상소치，속우관절내골절，수술시최가치료방식。단골절류형、수술입로、복위질량、년령、수술시궤등회대치료효과산생영향。인차，분석영향수술효과적관건인소십분필요。<br> 목적：탐토수술치료관구골절후영향관관절공능회복적인소。<br> 방법：선택2010년1월지2013년10월수술치료차수방자료완정적관구골절환자42례，18례채용Kocher-Langenbeck입로，14례채용가복고구입로，10례채용전후연합입로。술후채용Matta표준평정골절복위정황。채용개량적Merled' Aubigne-Postel평분계통평개환자관관절공능。대가능영향수술료효적지표（여성별、년령、수술시궤、골절류형、수술입로、복위질량등）진행단인소급다인소Logistic회귀분석，사사영향수술료효적위험인소。<br> 결과：술후14례체도해부복위，20례량호복위，8례일반복위。절구균갑급유합，미출현감염。전부환자술후수방12~26개월，평균19개월。X선검사시골절우술후10~18주유합，평균14주。술후출현좌골신경손상4례，창상성관절염2례，고골두결혈배사2례，이위골화7례。술후6개월시관관절공능평정위우13례，량21례，가5례，차3례，우량솔위81%。단인소분석결과현시성별、년령、수술입로、관관절탈위여수술료효무명현관계（P＞0.05），이수술시궤、골절류형、복위질량、이위골화여수술료효유관（P＜0.05）。다인소분석현시골절류형、수술시궤、복위질량시영향수술효과적독립인소（P＜0.05）。<br> 결론：골절류형、수술시궤화복위질량시영향관구골절수술료효적독립인소，이후량자시상대가공적인소，치료시요선택합괄시궤、진량체도해부복위，이기획득량호적림상결국。
Background:Acetabular fracture is intraarticular fracture and mostly caused by high-energy injury. Surgical management is thought the best choice of treatment therapy. It is thought that the classification of fracture, surgical approach, quality of re-duction, age and time of surgical treatment may influence the clinical outcome of treatment. So it is essential to explore the key influential factors related to therapeutic effect. <br> Objective:To explore influential factors of recovery of hip joint function after surgical treatment for acetabulum fracture. <br> Methods: A total of 42 patients with acetabulum fracture treated in our hospital between January 2010 and October 2013 were enrolled in the retrospective study. Open reduction and internal fixation were performed in 18 cases through Kocher-Langenbeck approach, 14 cases through iliac inguinal approach, 10 cases anterior and posterior approach. The reduction quality was assessed by the Matta standard. The function of hip joint was evaluated by modified Merled' Aubigne-Postel grading system. Logistic regression analysis for single factor and multiple factors was used to screen risk factors, such as gender, age, operation time, fracture type, surgical approach, reduction, etc) related to surgical curative effect. <br> Results:Anatomical reduction was achieved in 14 cases, good reduction in 20 cases and fair reduction in 8 cases. Primary healing was seen in all incisions and no infection occurred. The mean period of follow-up was 19 months (range, 12-26 months). The mean fracture healing time was 14 weeks (range, 10-18 months). Injury of sciatic nerve occurred 4 cases, trau-matic arthritis in 4, ischemic necrosis of femoral head in 2, and heterotopic ossification in 7. The hip joint function was ex-cellent in 13 cases, good in 21, fair in 5, and bad in 3 at 6 months after surgery. Single factor analysis showed that gender, age, surgical approach, or dislocation of hip joint had no significant relation with therapeutic effect (P>0.05), but operation time, fracture type, quality of reduction, and heterotopic ossification were associated with curative effect (P<0.05). Multiple factors analysis showed that fracture type, operation time, reduction quality are the independent factors affecting clinical out-comes (P<0.05). <br> Conclusions:The classification of fracture, operation time and reduction quality are the independent factors influencing cu-rative effect on acetabulum fractures. Operation time and reduction quality are relatively controllable factors. Therefore, it is necessary to choose appropriate operation time in order to achieve anatomical reduction and obtain good clinical outcomes.
