• 四川大學(xué)華西醫(yī)院骨科（成都，610041）;

【摘 要】 目的  通過術(shù)后CT評價髖臼骨折復(fù)位質(zhì)量，探討累及負重區(qū)和非負重區(qū)的殘留移位（臺階移位和間隙移位）與術(shù)后髖關(guān)節(jié)功能的相關(guān)性。 方法  回顧分析2004年6月－2009年6月48例髖臼骨折患者術(shù)后CT檢查和臨床隨訪結(jié)果。患者均行切開復(fù)位內(nèi)固定。術(shù)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(jù)關(guān)節(jié)面殘留移位是否累及負重頂，將患者分為負重區(qū)組（30例）和非負重區(qū)組（18例）。髖關(guān)節(jié)功能按Merle d’Aubigné-Postel標準評定；術(shù)后關(guān)節(jié)面復(fù)位質(zhì)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(shù)據(jù)均采用Spearman秩相關(guān)檢驗分析。 結(jié)果  負重區(qū)組殘留移位值與髖關(guān)節(jié)功能成強負相關(guān)性（rs= —0.722，P=0.001）；非負重區(qū)組殘留移位值與髖關(guān)節(jié)功能無相關(guān)性（rs=0.481，P=0.059）。臨床隨訪結(jié)果與相關(guān)性分析一致。負重區(qū)組臺階移位值與髖關(guān)節(jié)功能成極強負相關(guān)（rs= —0.825，P=0.002），而間隙移位值與髖關(guān)節(jié)功能無相關(guān)性（rs=0.577，P=0.134）。 結(jié)論  髖臼骨折患者術(shù)后髖關(guān)節(jié)功能不僅與關(guān)節(jié)面殘留移位大小相關(guān)，還與殘留移位部位相關(guān)。與非負重區(qū)相比，累及負重區(qū)的殘留移位是影響術(shù)后髖關(guān)節(jié)功能的關(guān)鍵因素；在負重區(qū)臺階移位值越大，髖關(guān)節(jié)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(shù)后殘留移位與髖關(guān)節(jié)功能的相關(guān)性分析. 中國修復(fù)重建外科雜志, 2012, 26(3): 300-304. doi: 復(fù)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. 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. 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. 3. Letournel E, Judet R. Fracture of the acetabulum. 2nd ed. New York: Springer, 1993: 536-565.
  4. 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. 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. 6. McMaster J, Powell J. Acetabular fractures. Curr Orthop, 2005, (19): 140-154.
  7. 7. Mears DC, Velyvis JH, Chang CP. Displaced acetabular fractures managed operatively: indicators of outcome. Clin Orthop Relat Res, 2003, (407): 173-186.
  8. 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. 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. 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. 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. 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. 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. 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. 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. 16. Pascarella R, Maresca A, Reggiani LM, et al. Intra-articular fragments in acetabular fracture-dislocation. Orthopedics, 2009, 32(6): 402.
  17. 17. White MS. Three-dimensional computed tomography in the assessment of fractures of the acetabulum. Injury, 1991, 22(1): 13-19.
  18. 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. 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.