髖臼骨折術后殘留移位與髖關節功能的相關性分析_《中國修復重建外科雜志》

作者：

馬坤龍 , 方躍 , 欒富鈞 , 屠重棋 , 楊天府

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

髖臼骨折殘留移位髖關節功能負重區非負重區

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【摘要】目的 通過術后CT評價髖臼骨折復位質量，探討累及負重區和非負重區的殘留移位（臺階移位和間隙移位）與術后髖關節功能的相關性。方法回顧分析2004年6月－2009年6月48例髖臼骨折患者術后CT檢查和臨床隨訪結果。患者均行切開復位內固定。術后均獲隨訪，隨訪時間24～72個月，平均36個月；骨折均愈合。根據關節面殘留移位是否累及負重頂，將患者分為負重區組（30例）和非負重區組（18例）。髖關節功能按Merle d’Aubigné-Postel標準評定；術后關節面復位質量采用CT評價，于CT片上測量殘留移位的兩個指標（臺階移位和間隙移位）最大值。所得數據均采用Spearman秩相關檢驗分析。結果負重區組殘留移位值與髖關節功能成強負相關性（rs= —0.722，P=0.001）；非負重區組殘留移位值與髖關節功能無相關性（rs=0.481，P=0.059）。臨床隨訪結果與相關性分析一致。負重區組臺階移位值與髖關節功能成極強負相關（rs= —0.825，P=0.002），而間隙移位值與髖關節功能無相關性（rs=0.577，P=0.134）。結論髖臼骨折患者術后髖關節功能不僅與關節面殘留移位大小相關，還與殘留移位部位相關。與非負重區相比，累及負重區的殘留移位是影響術后髖關節功能的關鍵因素；在負重區臺階移位值越大，髖關節功能越差。

引用本文： 馬坤龍,方躍,欒富鈞,屠重棋,楊天府. 髖臼骨折術后殘留移位與髖關節功能的相關性分析. 中國修復重建外科雜志, 2012, 26(3): 300-304. doi: 復制

1.	10 d’Aubign é RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
2.	18 ? vre S, Madsen JE, R ø ise O. Acetabular fracture displacement, roof arc angles and 2 years outcome. Injury, 2008, 39(8): 922-931.
3.	Letournel E, Judet R. Fracture of the acetabulum. 2nd ed. New York: Springer, 1993: 536-565.
4.	Matta JM, Anderson LM, Epstein HC, et al. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res, 1986, (205): 230-240.
5.	Briffa N, Pearce R, Hill AM, et al. Outcomes of acetabular fracture fixation with ten years' follow-up. J Bone Joint Surg (Br), 2011, 93(2): 229-236.
6.	McMaster J, Powell J. Acetabular fractures. Curr Orthop, 2005, (19): 140-154.
7.	Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res, 2003, (407): 173-186.
8.	Borrelli J Jr, Ricci WM, Steger-May K, et al. Postoperative radiographic assessment of acetabular fractures: a comparison of plain radiographs and CT scans. J Orthop Trauma, 2005, 19(5): 299-304.
9.	Borrelli J Jr, Goldfarb C, Catalano L, et al. Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma, 2002, 16(7): 449-457.
10.	Judet R, Judet J, Letournel E. Fracture of the acetabulum: classification and surgical approches for open reduction. Preliminary report. J Bone Joint Surg (Am), 1964, 46: 1615-1646.
11.	Olson SA, Matta JM. The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report). J Orthop Trauma, 1993, 7(5): 402-413.
12.	Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
13.	Moed BR, Carr SE, Watson JT. Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clin Orthop Relat Res, 2000, (377): 57-67.
14.	Catalano LW, Cole RJ, Gelberman RH, et al. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg (Am), 1997, 79(9): 1290-1302.
15.	Kreder HJ, Hanel DP, McKee M, et al. X-ray film measurements for healed distal radius fractures. J Hand Surg (Am), 1996, 21(1): 31-39.
16.	Pascarella R, Maresca A, Reggiani LM, et al. Intra-articular fragments in acetabular fracture-dislocation. Orthopedics, 2009, 32(6): 402.
17.	White MS. Three-dimensional computed tomography in the assessment of fractures of the acetabulum. Injury, 1991, 22(1): 13-19.
18.	Cole RJ, Bindra RR, Evanoff BA, et al. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg (Am), 1997, 22(5): 792-800.
19.	Lefkoe TP, Walsh WR, Anastasatos J, et al. Remodeling of articular step-offs. Is osteoarthrosis dependent on defect size? Clin Orthop Relat Res, 1995, (314): 253-265.

1. 10 d’Aubign é RM, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. J Bone Joint Surg (Am), 1954, 36-A(3): 451-475.
2. 18 ? vre S, Madsen JE, R ø ise O. Acetabular fracture displacement, roof arc angles and 2 years outcome. Injury, 2008, 39(8): 922-931.
3. Letournel E, Judet R. Fracture of the acetabulum. 2nd ed. New York: Springer, 1993: 536-565.
4. Matta JM, Anderson LM, Epstein HC, et al. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res, 1986, (205): 230-240.
5. Briffa N, Pearce R, Hill AM, et al. Outcomes of acetabular fracture fixation with ten years' follow-up. J Bone Joint Surg (Br), 2011, 93(2): 229-236.
6. McMaster J, Powell J. Acetabular fractures. Curr Orthop, 2005, (19): 140-154.
7. Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res, 2003, (407): 173-186.
8. Borrelli J Jr, Ricci WM, Steger-May K, et al. Postoperative radiographic assessment of acetabular fractures: a comparison of plain radiographs and CT scans. J Orthop Trauma, 2005, 19(5): 299-304.
9. Borrelli J Jr, Goldfarb C, Catalano L, et al. Assessment of articular fragment displacement in acetabular fractures: a comparison of computerized tomography and plain radiographs. J Orthop Trauma, 2002, 16(7): 449-457.
10. Judet R, Judet J, Letournel E. Fracture of the acetabulum: classification and surgical approches for open reduction. Preliminary report. J Bone Joint Surg (Am), 1964, 46: 1615-1646.
11. Olson SA, Matta JM. The computerized tomography subchondral arc: a new method of assessing acetabular articular continuity after fracture (a preliminary report). J Orthop Trauma, 1993, 7(5): 402-413.
12. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg (Am), 1996, 78(11): 1632-1645.
13. Moed BR, Carr SE, Watson JT. Open reduction and internal fixation of posterior wall fractures of the acetabulum. Clin Orthop Relat Res, 2000, (377): 57-67.
14. Catalano LW, Cole RJ, Gelberman RH, et al. Displaced intra-articular fractures of the distal aspect of the radius. Long-term results in young adults after open reduction and internal fixation. J Bone Joint Surg (Am), 1997, 79(9): 1290-1302.
15. Kreder HJ, Hanel DP, McKee M, et al. X-ray film measurements for healed distal radius fractures. J Hand Surg (Am), 1996, 21(1): 31-39.
16. Pascarella R, Maresca A, Reggiani LM, et al. Intra-articular fragments in acetabular fracture-dislocation. Orthopedics, 2009, 32(6): 402.
17. White MS. Three-dimensional computed tomography in the assessment of fractures of the acetabulum. Injury, 1991, 22(1): 13-19.
18. Cole RJ, Bindra RR, Evanoff BA, et al. Radiographic evaluation of osseous displacement following intra-articular fractures of the distal radius: reliability of plain radiography versus computed tomography. J Hand Surg (Am), 1997, 22(5): 792-800.
19. Lefkoe TP, Walsh WR, Anastasatos J, et al. Remodeling of articular step-offs. Is osteoarthrosis dependent on defect size? Clin Orthop Relat Res, 1995, (314): 253-265.

《中國修復重建外科雜志》

髖臼骨折術后殘留移位與髖關節功能的相關性分析

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《中國修復重建外科雜志》

髖臼骨折術后殘留移位與髖關節功能的相關性分析

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Content

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