| 不稳定骨盆骨折合并髋臼骨折手术治疗的疗效分析 |
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投稿时间：2014-09-20
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| 作者 | Author | 单位 | Address | E-Mail |
| 王陶 |
WANG Tao |
绵阳市中心医院骨科, 四川 绵阳 621000 |
Department of Orthopaedics, Mianyang Central Hospital, Mianyang 621000, Sichuan, China |
wwaawwee@163.com |
| 王军 |
WANG Jun |
绵阳市中心医院骨科, 四川 绵阳 621000 |
Department of Orthopaedics, Mianyang Central Hospital, Mianyang 621000, Sichuan, China |
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| 李宗原 |
LI Zong-yuan |
绵阳市中心医院骨科, 四川 绵阳 621000 |
Department of Orthopaedics, Mianyang Central Hospital, Mianyang 621000, Sichuan, China |
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| 刘刚 |
LIU Gang |
绵阳市中心医院骨科, 四川 绵阳 621000 |
Department of Orthopaedics, Mianyang Central Hospital, Mianyang 621000, Sichuan, China |
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| 期刊信息：《中国骨伤》2015年，第28卷，第5期，第392-398页 |
| DOI：10.3969/j.issn.1003-0034.2015.05.002 |
| 基金项目: |
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中文摘要:
目的:探讨不稳定骨盆骨折合并髋臼骨折的治疗策略及临床疗效。
方法:2007年1月至2013年6月收治32例不稳定骨盆骨折合并髋臼骨折患者,男18例,女14例;年龄18～62岁,平均38岁。Tile骨盆骨折分型:B1型11例,B2.1型8例,B2.2型7例,C1.1型3例,C1.2型2例,C3型1例。Judet-Letournel髋臼骨折分型:前柱骨折1例,横形骨折8例,横形加后壁骨折6例,“T”形骨折1例,前柱加后半横形骨折5例,双柱骨折11例。早期处理其他合并损伤,待病情稳定后手术治疗。术后门诊随访,对髋关节功能及骨折的复位质量进行评价。
结果:患者手术时间1.8～6.5 h,平均3 h;术中失血450～3 200 ml,平均1 200 ml。有2例肥胖患者切口发生脂肪液化,换药后愈合,无切口感染病例。1例失访,31例获得随访,随访时间6～42个月,平均23个月。骨盆骨折愈合时间8～18周,平均10.6周。按照Matta和Tornetta的评分标准评价复位情况,优15例,良14例,可1例,差1例。Majeed功能评分为83.65±7.67,优15例,良12例,可4例。髋臼骨折愈合时间8～16周,平均10.2周。采用Matta评定标准评估术后复位质量,优15例,良12例,差4例。按Brooker标准评价异位骨化,Ⅰ度4例,Ⅱ度1例。无股骨头坏死及骨折不愈合发生,5例并有神经损伤者4～6个月后均完全恢复。
结论:不稳定骨盆骨折合并髋臼骨折患者早期病情危重,运用损伤控制理念及时抢救生命为主。后期把握手术时机,治疗时髋臼骨折尽量解剖复位,骨盆骨折以重建稳定为主,手术复位顺序先固定骨盆后环,根据病情选择合适的手术入路及固定方式。 |
| 【关键词】骨盆 髋臼 骨折 外科手术 |
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| Surgical treatment of unstable pelvic fractures combined with acetabular fractures |
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ABSTRACT
Objective:To discuss the treatment strategy of acetabular fractures and unstable pelvic fracture of the hip and to evaluate its outcome.
Methods:Retrospective analysis of clinical data in 32 patients with unstable pelvic fracture and acetabular fractures from January 2007 to June 2013 were collected. There were 18 males and 14 females aged from 18 to 62 years old (means 38 years old). According to Tile classification of pelvic fracture,11 cases were type B1,8 were type B2.1,7 were type B2.2,3 were type C1.1,2 were type C1.2,1 was type C3. According to Judet-Letournel classification,anterior column fracture was in 1 case,transverse fracture in 8,transverse plus posterior wall fracture in 6,T-type fracture in 1,anterior column plus half transverse fractures in 5,double column fracture in 11. Other combined injuries were treated early,the surgical operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during follow-up.
Results:The operative time was from 1.8 to 6.5 hours (averaged 3 hours). Two fat patients'incision occurred in fat liquefaction and healed after dressing,no incision infection happened. Only 1 case was lost to follow-up,31 patients were followed up with a mean time of 23 months (6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks (averaged in 10.6 weeks). The hip function was evaluated according to the Matta and Tornetta standard postoperatively,the result was excellent in 15 cases,good in 14 cases,fair and poor in 1 case respectively. The Majeed score of the hip function was 83.65±7.67,the result was excellent in 15 cases,good in 12 cases and fair in 4 cases. The healing time of acetabular fractures was from 8 to 16 weeks (averaged in 10.2 weeks). The fracture reduction was assessed by Matta standard,the result was excellent in 15 cases,good in 12 cases and fair in 4 cases. The heterotopic ossification was evaluated by Brooker standard,4 cases were gradeⅠ,1 case was gradeⅡ. There were no infection,nonunion and necrosis of the femoral head in all patients. The nerve damage symptoms in 5 patients disappeared during 4 to 6 months after operation.
Conclusion:Patients with unstable pelvic fractures and acetabulum fractures were in a critical condition early,using the concept of damage control to save lives in a timely manner. Grasp the operation time in the late treatment,acetabulum fractures reach anatomical reduction as far as possible,pelvic fractures are given priority to stable reconstruction. The operation order was fixed pelvic ring first,according to the condition to choose the appropriate surgical approach and fixed mode. |
| KEY WORDS Pelvis Acetabulum Fractures Surgical procedures,operative |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 王陶,王军,李宗原,刘刚.不稳定骨盆骨折合并髋臼骨折手术治疗的疗效分析[J].中国骨伤,2015,28(5):392~398 |
| 英文格式: | WANG Tao,WANG Jun,LI Zong-yuan,LIU Gang.Surgical treatment of unstable pelvic fractures combined with acetabular fractures[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(5):392~398 |
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