经腹直肌外侧切口入路治疗髋臼骨折合并同侧骨盆骨折  

Lateral-rectus approach for treatment of acetabular fracture combined with ipsilaterai pelvic fracture

作　　者：熊然[1] 张潇[1] 李涛[1] 燕华[1] 王华[1] 麦奇光[1] 韩卫雨[1] 黄海[1] 廖坚文[1] 吴文[1] 樊仕才[1] 

机构地区：[1]南方医科大学第三附属医院骨科,广东省骨科研究院,广州510630

出　　处：《中华创伤骨科杂志》2014年第5期385-390,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨经腹直肌外侧切口入路治疗髋臼骨折合并同侧骨盆骨折的临床疗效. 方法 回顾性分析2011年3月至2013年3月采用经腹直肌外侧切口入路治疗的15例髋臼骨折合并同侧骨盆骨折患者资料,男10例,女5例;年龄为21 ～ 64岁,平均45.6岁.髋臼骨折按Judet-Letournel分型：前柱骨折8例,前柱伴后半横形骨折3例,双柱骨折4例;骨盆骨折按Tile分型：B2.1型5例,C1.2型7例,C1.3型3例.受伤至手术时间为5～21 d,平均11d.11例单纯骨盆、髋臼前部分骨折患者,采用平卧位,行经腹直肌外侧切口入路复位与固定;4例骨折涉及髋臼后壁、后柱者,采用漂浮体位,行腹直肌外侧切口入路联合后侧Kocher-Langenbeck入路复位与固定.内固定物为钛合金重建接骨板及空心螺钉. 结果 本组患者手术时间平均为105 min,术中出血量平均为640 mL.术后髋臼骨折复位质量按照Matta影像学复位评估标准评定：解剖复位8例,满意复位4例,不满意复位3例.1例患者出现坐骨神经损伤症状,1例患者出现腹壁伤口皮下脂肪液化.15例患者术后获平均16个月（10 ～20个月）随访.本组患者骨折愈合时间平均为12周（10 ～15周）.术后6个月根据改良Merled＇Aubigne和Postel评分系统评定疗效：优10例,良4例,可1例.结论 经腹直肌外侧切口入路术中能充分显露并处理累及髋臼前柱和方形区的髋臼骨折,并可对同侧耻骨上支、髂骨翼及骶髂关节周围骨折进行有效的复位与固定,疗效良好.Objective To explore the clinical effect of lateral-rectus approach for the intemal fixation of acetabular fractures with concurrent ipsilateral pelvic fracture.Methods From March 2011 to March 2013,15 patients with acetabular fracture and ipsilateral type C pelvic fracture were surgically managed through the lateral-rectus approach.They were 10 males and 5 females,with an average age of 45.6 years （from 21 to 64 years）.According to Judet-Letournel classification,there were 8 anterior column fractures,3 anterior column plus posterior hemitransverse fractures,and 4 double column fractures.All the cases had concurrent pelvic fractures.By Tile classification,there were 5 cases of type B2.1,7 ones of type C1.2,and 3 ones of type C1.3.The duration from injury to surgery ranged from 5 to 21 days,averaging 11 days.Eleven cases of merely anterior acetabular and pelvic fractures were treated with the lateral-rectus approach only,in the supine position.Four cases involving the posterior acetabular wall and posterior column were treated with combined lateral-rectus and posterior Kocher-Langenbeck approaches,in the floating position.The titanium reconstruction plates and cannulated screws were applied in these cases.Results The operation time averaged 105 minutes and the intraoperative blood loss 640 mL.Postoperative X-ray and CT exams showed excellent and good reduction.According to the Matta radiological evaluation postoperatively,reduction of acetabular fracture was rated as anatomic in 8 cases,satisfactory in 4 and unsatisfactory in 3.Injury to the sciatic nerve occurred in one case,and fat liquefaction at the abdominal incision in one case.All the patients were followed up for 10 to 20 months （average,16 months） and the fractures healed after 10 to 15 weeks （average,12 weeks）.According to the modified Merle d＆#39;Aubigne and Postel scoring system,10 cases were excellent,4 good,and one fair 6 months after operation.Conclusions Surgical management of acetabular fractures through the lateral-rectus approach c

关 键 词：髋臼 骨盆 骨折 手术入路 

分 类 号：R687.3[医药卫生—骨科学]