【摘要】：目的： 本研究的目的在于就我院近年對髖臼頂骨折實(shí)施微創(chuàng)手術(shù)治療的患者進(jìn)行隨訪，探討手術(shù)方法及其術(shù)后療效，從而對髖臼頂區(qū)骨折的微創(chuàng)治療提供相關(guān)理論依據(jù) 方法： 選擇我院收治髖臼頂骨折患者26例，男16例，女10例，年齡23～79歲，平均52歲有并發(fā)癥者12例，其中糖尿病4例，冠心病2例，高血壓6例;按致傷原因:車禍傷19例，高空墜落5例，重物砸傷2例合并傷：內(nèi)臟破裂３例，四肢骨折９例，顱腦外傷2例，后脫位2例數(shù)，胸部挫傷1例所有患者在情況穩(wěn)定后，三周內(nèi)（３～２１ｄ）手術(shù)所有脫位術(shù)前皆行閉合復(fù)位并行股骨髁上骨牽引以手術(shù)時間ǐ術(shù)中出血量ǐ住院時間ǐ臥床時間ǐ骨折復(fù)位情況ǐ術(shù)后功能恢復(fù)狀態(tài)的情況作為手術(shù)的觀察指標(biāo)，以疼痛程度ǐ髖關(guān)節(jié)的功能ǐ畸形和髖關(guān)節(jié)活動為指標(biāo)對手術(shù)效果進(jìn)行評價(jià) 結(jié)果： 本組患者26例均順利的完成手術(shù)，手術(shù)切口長10～15厘米，平均約12厘米，手術(shù)時間55～110分鐘，平均約82分鐘，術(shù)中失血量220～480毫升，平均約390毫升住院時間13～20天，平均約15天，臥床時間7～14天，平均約9天髖臼骨折的復(fù)位具體情況根據(jù)Matta標(biāo)準(zhǔn)［2］來評價(jià):髖臼骨折的復(fù)位達(dá)到解剖復(fù)位的患者有21例(骨折斷端的移位未超過1毫米)，復(fù)位達(dá)到滿意復(fù)位的患者有5例(骨折的斷端移位未超過3毫米)，只有一例患者的復(fù)位為不滿意(骨折的斷端移位超過了3毫米)根據(jù)D'Aubigne-Postel標(biāo)準(zhǔn)用來評價(jià)髖關(guān)節(jié)的功能:16例患者為優(yōu)，5例患者達(dá)到良好，可的有4例，只有1例患者為差1例糖尿病患者在術(shù)后第3天傷口紅腫，，經(jīng)過控制血糖ǐ切口加強(qiáng)換藥后控制無1例發(fā)生深靜脈的血栓ǐ尿路的感染，無1例發(fā)生神經(jīng)血管的損傷 結(jié)論： 微創(chuàng)治療髖臼頂區(qū)骨折手術(shù)效果顯著，具有手術(shù)出血量少ǐ創(chuàng)傷小ǐ異位骨化并發(fā)癥少ǐ安全可靠ǐ且術(shù)后早期可行功能鍛煉ǐ恢復(fù)好等優(yōu)點(diǎn)，可以減輕病人所承受的痛苦，降低患者住院時間，而且更適合老年人髖臼骨折的手術(shù)治療
[Abstract]:Objective: the purpose of this study was to follow up the patients with acetabular parietal fracture treated by minimally invasive operation in our hospital in recent years, and to explore the operative method and the effect after operation. So as to provide relevant theoretical basis for minimally invasive treatment of acetabular parietal fracture: 26 cases of acetabular parietal fracture were treated in our hospital, 16 males and 10 females, aged 23 to 79 years. There were 12 cases of complications in 52 years old, including 4 cases of diabetes mellitus, 2 cases of coronary heart disease, 6 cases of hypertension, according to the cause of injury: 19 cases of traffic accident injury, 5 cases of falling from high altitude, 2 cases of combined injury of heavy object injury: 3 cases of visceral rupture and 9 cases of limb fracture. There were 2 cases of craniocerebral trauma, 2 cases of posterior dislocation and 1 case of thoracic contusion. Within 3 weeks (3 ~ 21 days), all dislocation were treated with closed reduction before operation and supracondylar traction of the femur for the duration of operation, the amount of blood lost during operation, the time of stay in bed, the reduction of fracture and the recovery of function after operation. As an indication of the operation, The effect of the operation was evaluated by the functional deformity of hip joint and the hip joint activity. The results showed that 26 patients were successfully operated, the incision was 1015cm long. The average operation time was about 12 cm, the operation time was 55 ~ 110 minutes (mean 82 minutes), the blood loss during the operation was 220 ~ 480 ml, the average hospitalization time was about 390 ml for 1320 days, the average was about 15 days, and the bed rest time was 7 ~ 14 days. According to Matta criteria, 21 patients with acetabular fracture achieved anatomic reduction (the displacement of the broken end of the fracture was not more than 1 mm), and the reduction achieved satisfactory reduction. Five of the patients (the broken end displacement of the fracture was not more than 3 mm), and only one patient was dissatisfied with the reduction (the broken end displacement of the fracture exceeded 3 mm), and the function of hip joint was evaluated according to D'Aubigne-Postel criteria in 16 patients. 5 patients achieved good results, Of the 4 cases, only one case was poor. 1 case of diabetes mellitus suffered from wound redness and swelling on the 3rd day after operation. No infection of deep vein thrombus and urinary tract was controlled after enhanced dressing change through the incision of blood glucose control. Conclusion: minimally invasive treatment of acetabular parietal fracture was effective. It has the advantages of less operative bleeding, less trauma, less ectopic ossification complications, less safety and reliability, and better recovery of early feasible functional exercise after operation, which can alleviate the suffering of the patients and reduce the hospitalization time of the patients. It is also more suitable for the surgical treatment of acetabular fractures in the elderly.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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