Surgical treatment of unstable pelvic fractures combined with acetabular fractures
10.3969/j.issn.1003-0034.2015.05.002
- VernacularTitle:不稳定骨盆骨折合并髋臼骨折手术治疗的疗效分析
- Author:
Tao WANG
1
;
Jun WANG
;
Yuan Zong LI
;
Gang LIU
Author Information
1. 绵阳市中心医院骨科
- Keywords:
Pelvis;
Acetabulum;
Fractures;
Surgical procedures,operative
- From:
China Journal of Orthopaedics and Traumatology
2015;(5):392-398
- CountryChina
- Language:Chinese
-
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 col?umn 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 surgi?cal operation were performed after stable condition. The hip joint function and the fracture reduction were assessed during fol?low up. Results:The operative time was from 1.8 to 6.5 hours(averaged 3 hours). Two fat patients'incision occurred in fat liq?uefaction and healed after dressing,no incision infection happened. Only 1 case was lost to follow up,31 patients were fol?lowed up with a mean time of 23 months(6 to 42 months). The healing time of pelvic fracture was from 8 to 18 weeks(aver?aged 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 excel?lent 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 con?dition to choose the appropriate surgical approach and fixed mode.
