不同手术入路在髋臼骨折治疗中的应用  

The Application of the Different Approach Surgery in Treatment of Acetabular Fracture

作　　者：左春光 刘继军[1] 王新虎[1] 王建顺[1] 

机构地区：[1]宝鸡市中心医院脊柱外科,陕西宝鸡721008

出　　处：《实用骨科杂志》2010年第2期101-103,共3页Journal of Practical Orthopaedics

摘　　要：目的探讨不同手术入路在髋臼骨折治疗中的应用。方法选取2005年4月至2008年4月收治的各类髋臼骨折23例,男14例,女9例,年龄22～58岁。骨折依据Letournel分型,根据不同骨折类型采用不同手术入路进行骨折切开复位内固定术,10例采用Kocher-Langenbeck入路,8例采用髂腹股沟入路,5例采用Kocher-Langenbeck及髂腹股沟联合入路。结果术后随访时间为12～26个月,平均随访18个月,髋臼骨折复位效果采用Matta标准进行X线评估,18例获得解剖复位,3例复位良好,2例复位较差。临床效果评估采用改良的Merled′Aubigne和Postel评分系统,优17例,良3例,一般0例,差3例,优良率为86.96%。23例患者中3例出现术后并发症,1例为腹股沟疝,1例发生睾丸鞘膜积液,1例为坐骨神经牵拉伤。结论术前三维CT扫描对骨折的分型及手术入路的选择有重要意义。多数情况运用单一的Kocher-Langenbeck或髂腹股沟入路均可使骨折的显露和复位问题得到解决。对于复杂的髋臼骨折或合并骨盆骨折、髋关节脱位者,依据骨折情况,可考虑采用Kocher-Langenbeck及髂腹股沟联合入路。Objective To investigate the application of the different approach surgery in treatment of acetabular fracture. Method 23 cases collected from April 2005 to April 2008.14 patients were male,9 patients were femal. The age range from 22 years to 58 years. All cases classified according to Letoumel-Judet system and underwent open re- duction through different approachs. 10 cases underwent through Kocher-Langenbeck approach. 8 eases underwent through ilionguinal approach. 5 cases underwent through combined Kocher Langenbeck and ilionguinal approach. Re- suits The follow-up period ranged from 12 to 26 months, average period was 18 months. Effects of surgery evaluated according to Matta imaging score,there were 18 cases anatomical reduction, 3 cases satisfactional reduction and 2 cases showed dissatisfactory reduction. Clinical effects evaluated according to modified＇Aubigne and Postel score. There were 17 cases excellent, 3 cases good, 0 cases fair, 3 cases bad. Excellent and good rate was 86.96 ~. In postoperation, there were three cases that had complication, one case taken place inguinal hernia, one cases taken place hydrocele of testis and one cases taken place sciatic nerve injure. Conclusion Preoperation 3D-CT scan was very important to ac- curate classifaction of fracture and proper choicing of surgical approach, the surgical exposure and reduction in most aeetabular fracture was resolved through only using Kocher-Langenbeck approach or ilionguinal approach. According to the situation of fracture,the combined Kocher-Langenbeck and ilionguinal approach was used in the complex ac- etabular fracture and the fracture combined pelvic fracture or hip dislocation.

关 键 词：髋臼骨折 手术入路 治疗 

分 类 号：R683.3[医药卫生—骨科学]