髂腹股沟微创小切口内固定治疗髋臼前柱或耻骨支骨折  

Internal fixation for fractures of the acetabular anterior column or pubic rami through minimally invasive ilioinguinal approach

作　　者：李连欣[1] 周东生[1] 杨永良[1] 郝振海[1] 王永会[1] 

机构地区：[1]山东大学附属省立医院创伤骨科,济南250021

出　　处：《中华骨科杂志》2012年第5期467-470,共4页Chinese Journal of Orthopaedics

基　　金：山东省优秀中青年科学家科研奖励基金（2008BS03054）

摘　　要：目的探讨经髂腹股沟微创小切口内固定治疗髋臼前柱或耻骨支骨折的临床效果。方法2008年6月至2011年6月，对16例髋臼前柱骨折、10例耻骨支骨折患者采用髂腹股沟微创小切口内固定治疗。所有患者均采用全麻，于髂结节至髂前上棘做3-5cm斜行切口，沿髂骨内侧骨膜下剥离至髂前下棘、髂耻隆起、髋臼前柱，再于耻骨结节向外2-3em横行切口，沿耻骨支前上方骨膜下剥离显露耻骨支，两个切口分别向中间潜行剥离后形成沿耻骨支髋臼前柱相贯通的骨膜下隧道，复位骨折，将重建钛板预弯后导入隧道，固定骨折。结果根据Matta标准，术后解剖复位13例，复位良好11例，复位较差2例。23例患者获得平均15．6个月随访（6-30个月）。髋关节功能按照D’Aubigne评分：优13例，良6例，可4例。骨盆功能按照Majeed评分：优12例，良9例，可2例。无感染、股神经或股血管损伤、静脉血栓、异位骨化等并发症发生。结论经髂腹股沟微创小切口内固定治疗髋臼前柱或耻骨支骨折创伤小，手术时间短，安全性相对较高。髂耻前柱放置钢板对钢板塑形的要求低，固定可靠。Objective To explore the clinical effect of internal fixation for fractures of the acetabular anterior column or pubic rami through minimally invasive ilioinguinal approach. Methods From June 2008 to June 2011, 26 patients were surgically fixed with reconstructive plates through minimally invasive ilioinguinal approach. Sixteen cases were diagnosed as fractures of the acetabular anterior column, and ten as fractures of the pubic rami. The patient was positioned supine or lateral floating. The incision included two parts. The lateral part along the anterior one-third of the iliac crest about 3-5 cm. The insertion of the abdominal muscles and the origin of the iliacus were sharply incised from the crest. By subperiosteal dissection, the iliacus was elevated from the internal iliac fossa as far medially as to expose th anterior inferior iliac spine, iliopubic eminence and acetabular anterior column. The medial part of the incision was from the pubic tubercle transverse lateral extend 2-3 cm. Subperiosteal dissection to expose the superior pubic ramus. Two windows were dissected subperiosteal to connect through a tunnel along the anterior column of the acetabulum and pubic ramus. Fractures were reduced, and reconstruction plates were contoured and placed through the tunnel. Two or three screws were used at each window to fix the fractures. Results According to Matta evaluation system, anatomic reductions of the hip were in 13 cases, good in 11 and fair in 2 cases. Twenty-three patients were followed up from 6 to 30 months （mean, 15.6 months）. Hip functions were excellent in 13 patients, good in 6, and fair in 4 patients according to the D＇Aubigne scores system. Pelvic functional results showed 12 were excellent, 9 were good and 2 were fair according to Majeed scores system. No complications such as infection or deep venous thrombosis occurred. Conclusion This modified ilioinguinal approach, with less operation time and low rate of complications, is simple and minimally invasive. It is easy for surgeons to perfo

关 键 词：骨盆 髋臼 骨折固定术 内 外科手术 微创性 

分 类 号：R687.3[医药卫生—骨科学]