CAJ | 학술논문

目的探讨不稳定型骨盆骨折合并髋臼骨折的手术治疗方式及临床预后. 方法回顾性分析2013年1月至2014年12月期间收治的21例不稳定型骨盆骨折合并髋臼骨折患者资料,男18例,女3例;年龄为21 ～ 55岁,平均43.2岁.骨盆骨折根据Tile分型:B型12例,C型9例;髋臼骨折根据Letournel-Judet分型:横形骨折11例,双柱骨折5例,后柱伴后壁骨折3例,前柱骨折2例.受伤至手术时间为4～15d,平均6.5d.所有患者均采用手术治疗. 结果 21例患者术后获6～18个月(平均9个月)随访.术后骨盆骨折复位质量按照骨盆Matta评分标准评定:优5例,良12例,可4例,优良率为81.0％;髋臼复位质量按照髋臼Matta评分标准评定:优5例,良11例,差5例,优良率为76.2％.骨盆骨折愈合时间为12 ～ 18周(平均14.5周),髋臼骨折愈合时间为12 ～ 22周(平均15.5周).末次随访时按照Majeed评分标准评定疗效:优10例,良8例,可3例,优良率为85.7％;按照改良Merle d'Aubigné和Postel评分系统评定疗效:优8例,良9例,可4例,优良率为81.0％.3例伤后合并马尾神经损伤症状的患者均于术后4～6个月恢复正常.伤口感染2例,经2次清创术后感染得以控制.随访期间无一例患者发生异位骨化及股骨头缺血性坏死、医源性血管、神经损伤等. 结论准确诊断,合理、完善的术前规划,细致的手术操作,有效复位、手术固定不稳定型骨盆骨折合并髋臼骨折,积极进行功能康复锻炼,能够取得良好的治疗效果.
목적 탐토불은정형골분골절합병관구골절적수술치료방식급림상예후. 방법 회고성분석2013년1월지2014년12월기간수치적21례불은정형골분골절합병관구골절환자자료,남18례,녀3례;년령위21 ～ 55세,평균43.2세.골분골절근거Tile분형:B형12례,C형9례;관구골절근거Letournel-Judet분형:횡형골절11례,쌍주골절5례,후주반후벽골절3례,전주골절2례.수상지수술시간위4～15d,평균6.5d.소유환자균채용수술치료. 결과 21례환자술후획6～18개월(평균9개월)수방.술후골분골절복위질량안조골분Matta평분표준평정:우5례,량12례,가4례,우량솔위81.0％;관구복위질량안조관구Matta평분표준평정:우5례,량11례,차5례,우량솔위76.2％.골분골절유합시간위12 ～ 18주(평균14.5주),관구골절유합시간위12 ～ 22주(평균15.5주).말차수방시안조Majeed평분표준평정료효:우10례,량8례,가3례,우량솔위85.7％;안조개량Merle d'Aubigné화Postel평분계통평정료효:우8례,량9례,가4례,우량솔위81.0％.3례상후합병마미신경손상증상적환자균우술후4～6개월회복정상.상구감염2례,경2차청창술후감염득이공제.수방기간무일례환자발생이위골화급고골두결혈성배사、의원성혈관、신경손상등. 결론 준학진단,합리、완선적술전규화,세치적수술조작,유효복위、수술고정불은정형골분골절합병관구골절,적겁진행공능강복단련,능구취득량호적치료효과.
Objective To explore the treatment and clinical outcomes of unstable combined fractures of pelvis and acetabulum.Methods From January 2013 through December 2014,21 unstable pelvic fractures associated with acetabular fractures received surgical treatment at our department.They were 18 men and 3 women,aged from 21 to 55 years (average,43.2 years).By the Tile classification for pelvic fractures,12 cases were type B and 9 type C.By the Letourel-Judet classification for acetabular fractures,11 cases were transverse fractures,5 both-column fractures,3 posterior column + posterior wall fractures,and 2 anterior column fractures.The intervals between injury and surgery averaged 6.5 days (from 4 to 15 days).Results The 21 cases were followed up for 6 to 18 months (average,9 months).According to the Matta's criteria for pelvic reduction,5 cases were excellent,12 good,and 4 fair,giving an excellent to good rate of 81.0％.According to the Matta's criteria for acetabular reduction,5 cases were excellent,11 good,and 5 poor,giving an excellent to good rate of 76.2％.The pelvic fractures healed after 12 to 18 weeks (average,14.5 weeks);the acetabular fractures healed after 12 to 22 weeks (average,15.5 weeks).According to the Majeed's functional evaluation at the last follow-ups,10 cases were excellent,8 good and 3 fair,giving an excellent to good rate of 85.7％.According to the Merle d'Aubigné-postel evaluation,8 cases were excellent,9 good,and 4 fair,giving an excellent to good rate of 81.0％.Three patients had nerve injury which was almost completely recovered 4 to 6 months after operation.Two cases had wound infection which was controlled after debridement for twice.No other complications like ectopic ossification,avascular necrosis of the femoral head,iatrogenic vascular or nerve lesion was observed during the follow-ups.Conclusion Precise diagnosis,rational plan,careful surgery,effective reduction,rigid fixation and active rehabilitation are keys to fine outcomes in the treatment of unstable pelvic fractures associated with acetabular fractures.