髋臼四方区复杂型骨折手术入路的选择  

Choice of operative approaches for complex fractures of the quadrilateral area of acetabular

作　　者：毕大卫[1] 韩雷[2] 祖罡[1] 郑琦[3] 费骏[3] 魏威[3] 顾军[3] 马海涛[1] 陈亿民[1] 胡钢锋[1] 

机构地区：[1]杭州市萧山第一人民医院,浙江杭州311200 [2]杭州市萧山区中医院,浙江杭州311201 [3]杭州市红十字会医院,浙江杭州311003

出　　处：《中国骨伤》2013年第11期944-948,共5页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2011KYB091)~~

摘　　要：目的:根据复杂型髋臼四方区骨折的不同类型,探讨不同手术入路,以获得更好的手术暴露和更可靠的复位内固定。方法:自2006年1月至2011年1月共收治58例髋臼四方区骨折,男36例,女22例;年龄23～61岁,平均36.9岁。术前摄骨盆片及双斜位片,辅以CT扫描重建髋臼,按Letournel分型其中前柱15例,横形12例,T形7例,前柱伴后半横形9例,双柱骨折15例。分别采用单纯Kocher-Langenbeck(K-L)入路、髂腹股沟入路、改良的Stoppa入路手术、组合式联合手术入路,或者经改良Stoppa入路结合经皮髋臼前柱拉力螺钉固定。结果:49例患者获随访,时间2～6年,平均32个月,术后其中1例发生深部感染,经创口引流,配合有效抗生素后治愈,2例出现坐骨神经损伤,2例出现股骨头坏死。手术结果复位按Matta标准评定:解剖复位(移位<1 mm)36例,满意复位(移位1～3 mm)8例,不满意复位(移位>3 mm)5例。关节功能按Merle d'Aubigne和Postel标准评定:优32例,良12例,可4例,差1例,总分(15.3±2.5)。结论:采用单一的手术入路只能解决一部分类型的髋臼复杂型四方区骨折,更多的需要采用联合入路,改良的Stoppa入路结合髂腹股沟前入路或者结合前柱髋臼螺钉通常是解决复杂型四方区骨折移位有效的手术入路,临床疗效满意。Objective ： To compare different surgical approaches in order to obtain better surgical exposure and more reliable reset fixation according to the different types of quadrilateral area fractures of acetabular. Methods： From January 2006 to January 2011,58 patients with the quadrilateral area fractures of acetabular were treated by surgical operation through the sim- ple Kocher-Langenbeek （KL） approach, ilioinguinal approach, modified Stoppa approach, or combined surgical approach, or a combination of anterior column screw fixation percutaneously and modify Stoppa approach. Results：Forty-nine patients were followed up for an average time of 32 months ranging from 2 to 6 years. One patient with deep infection cured after treatment of effective antibiotics and drainage, 2 patients had a sciatic nerve injury, 2 cases of avascular necrosis of the femoral head. Among them, 36 cases were anatomical reducted, 8 were good and 5 were poor according to Matta＇s radiographic assessment system. According to the mean Merle d＇Aubigne and Postel Score, 32 patients got excellent result, 12 good,4 fair and 1 bad, the average score was （15.3±2.5）. Conclusion： Single classic surgical approach can only use for some types of the complex quadrilateral area fractures of acetabular while combination approach may need for some fractures. Modified Stoppa approach combined with ilioinguinal approach or a combination of anterior column acetabular screw fixation are the most effective surgical approaches for complex quadrilateral area fractures of acetabular.

关 键 词：髋臼 骨折 骨折固定术 内 

分 类 号：R683.41[医药卫生—骨科学]