单一腹直肌外侧切口治疗髋臼前后柱骨折  

Operative treatment of acetabular both-column fracture through single lateral-rectus approach

作　　者：杨晓东[1] 夏广[1] 樊仕才[1] 王钢[2] 杜贵忠[3] 麦奇光[1] 王华[1] 李涛[1] 谭新宇[1] 

机构地区：[1] 南方医科大学第三附属医院骨科,广州510630 [2] 南方医科大学附属南方医院骨科 [3] 广东省惠州市惠阳区人民医院骨科

出　　处：《中华骨科杂志》2015年第4期335-340,共6页Chinese Journal of Orthopaedics

摘　　要：目的 探讨经单一前方腹直肌外侧切口前柱钢板加后柱顺行拉力螺钉固定治疗髋臼前后柱骨折的手术技巧及临床疗效.方法 回顾性分析2012年1月至2014年6月,采用单一前方腹直肌外侧切口前柱钢板加后柱拉力螺钉固定治疗28例髋臼前后柱骨折患者资料,男12例,女16例;年龄19～61岁,平均41.4岁.髋臼骨折按Letournel-Judet分型：前方伴后半横形骨折18例,双柱骨折10例,骨折均未涉及髋臼后壁;其中15例合并骨盆环骨折,9例合并四肢骨折,6例合并其他脏器损伤;13例为多发损伤.手术经前方腹直肌外侧切口进入,直视下复位髋臼骨折,将预弯的钢板放置于四方体的内侧面固定前柱,通过牵拉、撬拨复位后柱骨折,经小骨盆环上缘向坐骨棘或坐骨结节方向打入直径6.5 mm空心螺钉导针后,沿导针顺行拉力螺钉固定后柱.结果 28例患者均顺利完成手术.术后X线及CT检查均示髋臼前后柱骨折复位固定良好,无一例发生围手术期并发症.按Matta影像学复位标准：优20例,良5例,可3例,优良率89.2％（25/28）.28例患者均获得随访,随访时间6～18个月,髋臼骨折均愈合,愈合时间8～14周,平均12周.根据Matta改良的Merle d＇ Aubigne和Postel评分系统评价髋关节功能：优19例,良7例,可2例,优良率为92.8％（26/28）.2例分别于术后6、11个月行走时出现疼痛,影像学表现为髋关节创伤性关节炎,口服氨基葡萄糖片治疗,症状无明显改善.结论 经单一腹直肌外侧切口入路术中能充分显露髋臼前柱及后柱内侧面,并能直视下对髋臼前、后柱骨折进行有效复位与固定,疗效满意.Objective To explore the clinical effect and surgical skills of single lateral-rectus approach for the internal fixation of both-column acetabular fractures,in which the anterior column was fixed by reconstruction plates and the posterior column was fixed by antegrade lag screws.Methods From January 2012 to June 2014,28 patients with both-column acetabular fractures were surgically managed through a single lateral-rectus approach.They were 12 males and 16 females,with an average age of 41.4 （range,19-61） years.According to Judet-Letournel classification,there were 18 of anterior column with posterior hemitransverse fractures,10 of both-column fractures.All these fractures were treated through the lateral-rectus approach,in the horizontal position with general anesthesia.The pre-bended plate was placed in interior pelvic ring to fix the anterior column after reduction of the acetabular fracture.The ischial spine was exposed along the interior quadrilateral surface to reduce posterior column fractures.Then,the posterior column was fixed by antegrade lag screw （6.5 mm） after a hook-wire was implanted in posterior column along the ischial spine.Results All the 28 cases underwent the operation successfully.Postoperative X-ray and CT exams showed excellent or good reduction of anterior column and posterior column,without any operative complications.According to the Matta radiological evaluation,the reduction of acetabular fracture was rated as excellent in 20 cases,good in 5 cases and fair in 3 cases.The rate of excellent and good was 89.20% （25/28）.All patients were followed up for 6 to 18 months and all patients had achieved bone union.According to the modified Merle d＇Aubigne and Postel scoring system,19 cases were excellent,7 good,and 2 fair after operation.The rate of excellent and good was 92.8% （26/28）.2 cases occurred postoperative pain when walking,X-ray shows traumatic osteoarthritis.Conclusion Surgical management of acetabular fractures through a single lateral-rectus approach can provide a

关 键 词：髋臼 骨折 骨螺丝 

分 类 号：R687.3[医药卫生—骨科学]