CAJ | 학술논문

目的：探讨复杂髋臼后壁骨折的诊断及手术疗效。方法自2008年1月至2013年3月，以三种体位X线平片、CT扫描、CT三维图像重建技术诊断髋臼后柱合并后壁骨折42例、横形骨折合并后壁骨折18例。采用俯卧位Kocher－Langenbeck 入路，开放复位髋臼重建接骨板和拉力螺钉固定，治疗复杂髋臼后壁骨折。结果按Matta 评定标准，骨折解剖复位率80．49％、满意复位率8．54％、不满意复位率10．97％。术后早期并发症：坐骨神经损伤1例，股神经损伤1例，髂外动脉损伤血栓形成1例，下肢深静脉血栓形成2例；晚期并发症：异位骨化3例，股骨头坏死1例，髋关节创伤性关节炎2例。结论复杂髋臼后壁骨折正确诊断主要依靠骨盆前后位、闭孔斜位、髂骨斜位X线平片检查，对于判断髋臼骨折部位、类型非常重要，CT扫描提供髋臼冠状面骨折线、骨折块等清晰图像，为复杂髋臼后壁骨折的治疗，提供选择手术入路和内固定术方案有重要意义。
목적：탐토복잡관구후벽골절적진단급수술료효。방법자2008년1월지2013년3월，이삼충체위X선평편、CT소묘、CT삼유도상중건기술진단관구후주합병후벽골절42례、횡형골절합병후벽골절18례。채용부와위Kocher－Langenbeck 입로，개방복위관구중건접골판화랍력라정고정，치료복잡관구후벽골절。결과안Matta 평정표준，골절해부복위솔80．49％、만의복위솔8．54％、불만의복위솔10．97％。술후조기병발증：좌골신경손상1례，고신경손상1례，가외동맥손상혈전형성1례，하지심정맥혈전형성2례；만기병발증：이위골화3례，고골두배사1례，관관절창상성관절염2례。결론복잡관구후벽골절정학진단주요의고골분전후위、폐공사위、가골사위X선평편검사，대우판단관구골절부위、류형비상중요，CT소묘제공관구관상면골절선、골절괴등청석도상，위복잡관구후벽골절적치료，제공선택수술입로화내고정술방안유중요의의。
Objective To analyze the diagnosis and therapeutic efficacy of the surgery for complex acetabular fractures at the posterior wall .Methods From January 2008 to March 2013, 60 cases of complex acetabular fractures were enrolled .X ray images of three positions , CT scans were performed and three dimentional image reconstruction technique of CT was used to diagnose the fractures .Among the 60 cases, 42 cases were complex acetabular fractures in posterior column and posterior wall , and 18 cases were transverse fracture combining posterior wall fracture of the acetabulum .All the patients underwent surgical treatment which applied Kocher-Langenbeck approach with prone position , open reduction and steel plates and lag screws fixation to reconstruct the acetabulum .Results According to Matta standards , the anatomical reduction rate was 80.49%, the rate of satisfied reduction was 8.54%, and the rate of unsatisfied reduction was 10.97%.The early postoperative complications were as follows: one case of sciatic nerve injury , one case of femoral nerve injury , one case of external iliac artery injury with thrombosis, and two cases of deep vein thrombosis .The late postoperative complications were as follows:three cases of heterotopic ossification and one case of femoral head necrosis .Conclusions The correct diagnosis of complex acetabular fractures at posterior wall depends on the pelvic anterior -posterior radiograph, obturator oblique radiograph , and iliac oblique radiograph , which are important for determination of the locations and types of acetabular fractures .CT scan can provide clear images of the fracture lines and bone fragments on the coronal section of acetabulum , it is of great importance for doctors to choose the surgical approaches and internal fixation methods in the treatment of complex acetabular fractures at posterior wall .