改良髂腹股沟入路治疗髋臼前壁骨折  

Modified ilioinguinal approach for anterior wall fractures of the acetabulum

作　　者：陈戈[1] 欧艺[1] 陈仲[1] 赵航[1] 李欣[1] 

机构地区：[1]云南省第二人民医院创伤急救中心,昆明650021

出　　处：《中华创伤骨科杂志》2013年第11期956-960,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨改良髂腹股沟人路治疗髋臼前壁骨折的疗效。方法凹顺性分析2004年2月至2011年2月采用予术治疗的12例髋臼骨折患者资料，男10例，女2例；年龄为26～60岁，平均33．5岁。髋臼骨折按Letournel分型均为前壁骨折。受伤至手术时间为1～15d，平均5．4d。手术均采用改良髂腹股沟入路，6例患者前壁骨折块较大，采用拉力螺钉结合重建钢板固定；另6例患者前壁骨折粉碎，且其中4例伴有压缩，首先对压缩骨折进行撬拨复位，撬起后残存的缺损区取髂骨填充，然后采用拉力螺钉加弹性钢板结合重建钢板固定。末次随访时采用改良的Merled’Aubign6和Postel评分系统评定疗效。结果本组患者手术时间平均为100rain，术中出血量平均为350mL。12例患者术后获平均1．8年（1～5年）随访。术后骨折复位质量采用改良的Matta评分标准评定：优9例，良3例。骨折愈合时间平均为15周（11～18周）。末次随访时根据改良的Merled’Aubign6和Postel评分系统评定疗效：优8例，良3例，町1例。1例患者出现异位骨化，Brooker分级为I级。1例患者术后3年出现创伤性关节炎。无切口感染、内固定物松动、断裂及血管、神经损伤等并发症发生。结论改良髂腹股沟入路能较好地显露髋关节前上方结构，直视下复位髋关节前上方骨折，治疗粉碎、压缩的髋臼前蹙骨折效果良好。Objective To evaluate the modified ilioinguinal approach in tile treatment of anterior acetabulum wall fractures. Methods From February 2004 to February 2011, 12 patients with c.ommin- uted acetabular fracture were treated with modified ilioinguinal approach. They were 10 men and 2 women. 26 to 60 years of age （mean, 33.5 years） . All the fractures were anterior acetabulum wall ones according Io Letouruel classification. The time from injury to surgery ranged from 1 to 15 days （mean, 5.4 days）. All the operations were conducted via the modified ilioinguinal approach. In 6 patients whose fragments of the anlerior wall were relatively large, fixation was done with lag screws and a reconstruction plate; in another 6 patients who had severely comminuted fragments and were complicated with compression in 4, fixation was done with lag screws and a spring plate following leverage reduction and filling the defect with lilac bone. The outcomes were assessed at the last follow-up with improved Merle d＇Aubign6 and Postel evaluation system. Results The mean operation time and the mean blood loss during operation for the 12 patients was 100 minutes and 350 mL. The average follow-up time for the 12 patients was 1.8 years （range, 1 to 5 years） . By the Maria scoring, the postoperative reduction was rated as excellent in 9 and good in 3 cases. The fracture healing time averaged 15 weeks （from 11 to 18 weeks） . By the Merle d＇Aubign6 and Postel system, the outcomes were excellent in 8 cases, good in 3 cases and fair in one. One case of heterotopic ossification （Brooker degree I） was observed and one case of traumatic arthritis occurred 3 years after operation. No infection, implant fail- ure, or neurovascular lesion was found. Conclusion The modified ilioiuguinal approach is good for comminuted or impacted fractures of the anterior acetabulum wall, because it can better expose the anterior parts of the acetabulum and allow direct visualization of open reduction of the anterosuperior fractures of the hip jo

关 键 词：髋臼 骨折 骨折固定术 内 骨板 手术入路 

分 类 号：R687.3[医药卫生—骨科学]