Kocher-Langenbeck入路治疗髋臼横形骨折伴后壁骨折疗效分析  

EFFECTIVENESS OF ACETABULAR TRANSVERSE AND POSTERIOR WALL FRACTURES BY Kocher-Langenbeck APPROACH

作　　者：张里程[1] 许猛[1] 何纯青[1] 杜海龙[1] 陈华[1] 郭义柱[1] 陶笙[1] 张群[1] 梁向党[1] 唐佩福[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中国修复重建外科杂志》2010年第12期1428-1431,共4页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：国家高技术研究发展计划(863)资助项目(2008AA022403);解放军总医院创新基金资助项目(07CX103)~~

摘　　要：目的探讨Kocher-Langenbeck入路治疗髋臼横形骨折伴后壁骨折的临床疗效。方法 2002年1月-2009年2月,采用Kocher-Langenbeck入路显露并进行骨折复位固定治疗髋臼横形骨折伴后壁骨折17例。男12例,女5例;年龄20～65岁,平均33.4岁。车祸伤16例,高处坠落伤1例。受伤至入院时间6h～11d。骨折按Letournel分型标准均为复杂型骨折中的横形骨折伴后壁骨折。合并髋关节后脱位3例,四肢骨折8例,坐骨神经损伤3例,颅脑损伤1例,脾破裂1例。结果术后切口均Ⅰ期愈合,无感染及下肢深静脉血栓形成并发症发生。患者均获随访,随访时间12～36个月,平均19个月。X线片复查示骨折均愈合,愈合时间3～5个月。骨折复位按Matta等评定标准进行评价,获解剖复位9例,良好复位5例,较差复位3例。末次随访时根据改良Merle D’Aubigne和Postel髋臼骨折临床评分标准,获优4例,良9例,可3例,差1例,优良率76.5%。1例术后出现牵拉性坐骨神经损伤症状者与3例术前坐骨神经损伤者经对症处理后12个月神经功能完全恢复。术后9周～12个月出现创伤性关节炎5例,股骨头缺血性坏死1例,异位骨化5例。结论对于髋臼横形骨折伴后壁骨折,术前需完善影像学资料,尽早采用Kocher-Langenbeck入路切开复位,可取得满意疗效。Objective To investigate the surgical treatment effectiveness of acetabular transverse and posterior wall fractures by Kocher-Langenbeck approach. Methods Between January 2002 and February 2009, 17 patients with acetabular transverse and posterior wall fractures were treated with Kocher-Langenbeck approach and fracture reduction and fixation. There were 12 males and 5 females with an average age of 33.4 years （range, 20-65 years）. The disease causes were traffic accident in 16 cases and falling from height in 1 case. The disease duration was 6 hours to 11 days. According to Letournel classification, all fractures were rated as acetabular transverse and posterior wall fractures. Concomitant injuries included posterior hip dislocation in 3 cases, fracture of extremities in 8 cases, injury of sciatic nerve in 3 cases, craniocerebral injury in 1 case, and lienal rupture in 1 case. Results The incisions healed primarily and no complication of infection and deep venous thrombosis occurred after operation. All patients were followed up 12 to 36 months with an average of 19 months. The X-ray films showed that fracture healed 3 to 5 months after operation. After operation, anatomic reduction was found in 9 cases, satisfactory reduction in 5 cases, and unsatisfactory reduction in 3 cases according to Matta et al criterion. According to modified grading system of Merle D’Aubigne and Postel, the results were excellent in 4 cases, good in 9, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 76.5%. The nerve function was recovered in patients with sciatic nerve injury at 12 months after symptomatic treatment. Traumatic arthritis occurred in 5 cases, avascular necrosis of the femoral head in 1, and heterotopic ossification in 5 between 9 weeks and 12 months after operation. Conclusion For acetabular transverse and posterior wall fractures, it is important to make adequate preoperative preparation, to get the imaging data, and to perform open reduction and internal fixation with Kocher-Langenbec

关 键 词：髋臼横形骨折 后壁骨折 Kocher-Langenbeck入路 内固定 

分 类 号：R683.3[医药卫生—骨科学] R687.32[医药卫生—外科学]