累及负重区残留移位对髋臼骨折术后髋关节功能的影响
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摘要
目的探讨累及负重区的残留移位对髋臼骨折术后髋关节功能的影响。方法选取2011年3月—2014年5月宝鸡市中心医院收治的髋臼骨折87例,根据骨折是否累及负重区分为负重组45例与非负重组42例,两组均采取切开复位钢板内固定术。比较两组术后切口愈合情况、骨折愈合时间、并发症发生率、解剖复位率、髋关节功能优良率。分析残留移位患者累及负重区、残留移位部位与术后髋关节功能的相关性。结果 2组切口一期愈合率、骨折愈合时间、并发症发生率及复位质量、髋关节功能比较差异均无统计学意义(P>0.05)。负重组台阶移位值与间隙移位均大于非负重组,髋关节功能较非负重组差(P<0.05)。负重组残留移位与髋关节功能呈正相关(r=0.813,P<0.001)。残留台阶移位与髋关节功能呈正相关(r=0.834,P<0.001),残留间隙移位与髋关节功能无明显相关性(r=0.341,P>0.05)。结论累及负重区的残留移位大小及部位是影响髋臼骨折术后髋关节功能的重要因素,建议术中仔细复位以提高解剖复位率,避免负重区残留台阶移位。
Objective To investigate effect of residual and displacement involved in load-bearing area on function of hip joint in patients after acetabular fractures. Methods A total of 87 patients with acetabular fractures admitted during March 2011 and May 2014 were divided into load group( n = 45) and non-load group( n = 42) according to whether the fractures had been involved in load-bearing area or not. Both groups were treated with open reduction and plate internal fixation,and then incision healing conditions,fracture healing time,incidence rates of complications,anatomical reduction rate and excellent and good rate of hip joint function were compared between two groups. Relationship between residual and displacement involved in load-bearing area and postoperative hip joint function were analyzed. Results There were no significant differences in incision primary healing rate,time of fracture healing,incidence rate of complications,reduction quality and hip joint function between the two groups( P > 0. 05). In load group,values of step shift and gap shift were significantly higher,while hip joint function was worse than those in non-load group( P < 0. 05).In load group,residual and displacement involved in load-bearing area was positively correlated with hip joint function( r = 0. 813,P < 0. 001),and residual step shift displacement involved in load-bearing area was positively correlated with correlation with hip joint function( r = 0. 834,P < 0. 001),while interspace shift displacement showed no obvious correlation with hip joint function( r = 0. 341,P > 0. 05). Conclusion The size and location of the residual displacement involved in load-bearing area are important factors affecting hip joint function after acetabular fractures. It is suggested that the intraoperative reduction should be performed carefully to improve the anatomical reduction rate and avoid residual and step shift displacement involved in load-bearing area
Objective To investigate effect of residual and displacement involved in load-bearing area on function of hip joint in patients after acetabular fractures. Methods A total of 87 patients with acetabular fractures admitted during March 2011 and May 2014 were divided into load group( n = 45) and non-load group( n = 42) according to whether the fractures had been involved in load-bearing area or not. Both groups were treated with open reduction and plate internal fixation,and then incision healing conditions,fracture healing time,incidence rates of complications,anatomical reduction rate and excellent and good rate of hip joint function were compared between two groups. Relationship between residual and displacement involved in load-bearing area and postoperative hip joint function were analyzed. Results There were no significant differences in incision primary healing rate,time of fracture healing,incidence rate of complications,reduction quality and hip joint function between the two groups( P > 0. 05). In load group,values of step shift and gap shift were significantly higher,while hip joint function was worse than those in non-load group( P < 0. 05).In load group,residual and displacement involved in load-bearing area was positively correlated with hip joint function( r = 0. 813,P < 0. 001),and residual step shift displacement involved in load-bearing area was positively correlated with correlation with hip joint function( r = 0. 834,P < 0. 001),while interspace shift displacement showed no obvious correlation with hip joint function( r = 0. 341,P > 0. 05). Conclusion The size and location of the residual displacement involved in load-bearing area are important factors affecting hip joint function after acetabular fractures. It is suggested that the intraoperative reduction should be performed carefully to improve the anatomical reduction rate and avoid residual and step shift displacement involved in load-bearing area
引文
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[11]张志礼,卜海富.累及负重区髋臼骨折的手术治疗[J].临床骨科杂志,2013,16(3):274-277.
[12]肖俊,李涛,周军,等.髋臼骨折的Stoppa手术入路与手术策略[J].生物骨科材料与临床研究,2014,11(6):44-46.
[13]宋军,梅益彰,吴增城,等.复杂髋臼骨折复位及内固定的数字技术模拟研究[J].中国临床解剖学杂志,2013,31(4):393-396.
[14]郑小罕,邓进.移位髋臼骨折的手术治疗[J].创伤外科杂志,2016,18(5):305-306.
[15]白哲.改良前入路髂腹股沟切口手术治疗骨盆及髋臼骨折的临床效果研究[J].中国现代医生,2016,54(21):63-65.
[16]贺敬文.前后联合入路治疗复杂髋臼骨折的效果观察[J].中国综合临床,2014,30(4):424-425.
[17]康锦,刘晓伟,乔文海,等.复杂髋臼粉碎性骨折的手术治疗及近期疗效分析[J].中国临床医生,2013,41(2):36-38.
[18]张建辉,贺利军,贾帅军,等.32例髋臼骨折的手术治疗[J].武警后勤学院学报:医学版,2013,(9):823-824.
[19]黄家生,云致硕.3D打印技术在跟骨骨折手术治疗中的应用[J].中国医药科学,2016,6(10):198-200.
[20]张国明,周东生,贺宇,等.3D打印技术在复杂髋臼骨折治疗中的应用[J].中华创伤骨科杂志,2016,18(4):306-311.
[21]马坤龙,方跃,栾富钧,等.髋臼骨折术后残留移位与髋关节功能的相关性分析[J].中国修复重建外科杂志,2012,26(3):300-304.
[22]董伊隆,钱约男,黄祥祥,等.髋臼骨折不同台阶状移位及程度对髋关节接触特性的影响[J].解剖学报,2015,46(6):802-806.
[2]曾令源.髋臼骨折的分类与治疗策略[J].海南医学,2012,23(15):125-127.
[3]赵勇.锁定加压钢板内固定术治疗复杂性髋臼骨折疗效观察[J].山东医药,2012,52(22):79-80.
[4]崔可赜,张寿.髋关节后脱位合并髋臼后壁骨折的手术治疗[J].海南医学,2010,21(20):63-65.
[5]康锦,刘晓伟,张绪斌,等.复杂粉碎性髋臼骨折关节面重建修复的策略及预后[J].中国骨与关节外科,2011,4(2):114-118.
[6]张育锋,钟志刚,邱雪立,等.移位髋臼骨折手术治疗技巧探讨[J].中华创伤杂志,2011,27(10):924-928.
[7]薛锋,柴雷子,丁亮,等.改良Stoppa手术入路治疗骨盆及髋臼骨折的临床疗效[J].山东医药,2013,53(33):89-91.
[8]殷建新,李连欣.髂腹股沟与Stoppa入路手术治疗骨盆及髋臼骨折疗效对比观察[J].山东医药,2016,56(42):57-58.
[9]樊世峰.两种手术方法治疗髋臼骨折的临床效果分析[J].中国老年学杂志,2011,31(18):3605-3606.
[10]邱少东,王拯,朱涛,等.影响髋臼骨折手术预后的因素分析[J].中国矫形外科杂志,2016,24(10):884-888.
[11]张志礼,卜海富.累及负重区髋臼骨折的手术治疗[J].临床骨科杂志,2013,16(3):274-277.
[12]肖俊,李涛,周军,等.髋臼骨折的Stoppa手术入路与手术策略[J].生物骨科材料与临床研究,2014,11(6):44-46.
[13]宋军,梅益彰,吴增城,等.复杂髋臼骨折复位及内固定的数字技术模拟研究[J].中国临床解剖学杂志,2013,31(4):393-396.
[14]郑小罕,邓进.移位髋臼骨折的手术治疗[J].创伤外科杂志,2016,18(5):305-306.
[15]白哲.改良前入路髂腹股沟切口手术治疗骨盆及髋臼骨折的临床效果研究[J].中国现代医生,2016,54(21):63-65.
[16]贺敬文.前后联合入路治疗复杂髋臼骨折的效果观察[J].中国综合临床,2014,30(4):424-425.
[17]康锦,刘晓伟,乔文海,等.复杂髋臼粉碎性骨折的手术治疗及近期疗效分析[J].中国临床医生,2013,41(2):36-38.
[18]张建辉,贺利军,贾帅军,等.32例髋臼骨折的手术治疗[J].武警后勤学院学报:医学版,2013,(9):823-824.
[19]黄家生,云致硕.3D打印技术在跟骨骨折手术治疗中的应用[J].中国医药科学,2016,6(10):198-200.
[20]张国明,周东生,贺宇,等.3D打印技术在复杂髋臼骨折治疗中的应用[J].中华创伤骨科杂志,2016,18(4):306-311.
[21]马坤龙,方跃,栾富钧,等.髋臼骨折术后残留移位与髋关节功能的相关性分析[J].中国修复重建外科杂志,2012,26(3):300-304.
[22]董伊隆,钱约男,黄祥祥,等.髋臼骨折不同台阶状移位及程度对髋关节接触特性的影响[J].解剖学报,2015,46(6):802-806.