二腹肌大转子滑动截骨术治疗复杂髋臼骨折会增加并发症吗？  

Does digastric trochanteric flip osteotomy increase complications in treatment of complex acetabularfrsctures？

作　　者：张栋[1] 朱仕文[1] 王满宜[1] 

机构地区：[1]北京积水潭医院(北京大学第四临床医学院)创伤骨科,100035

出　　处：《中华创伤骨科杂志》2016年第2期95-101,共7页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：北京市医院管理局重点医学专业发展计划（ZYLX201506）

摘　　要：目的探讨Kocher-Lhngenbeck（K．L）入路联合二腹肌大转子滑动截骨术（DTFO）治疗复杂髋臼骨折是否会增加并发症。方法回顾性分析2009年12月至2013年12月收治的加例复杂髋臼骨折患者资料，根据手术入路不同分为2组：截骨组19例，男17例，女2例i平均年龄为（44．7±11。7）岁；采用K-L入路联合DTFO治疗O对照组2l例，男：17例，女4例；平均年龄为（42．8l±14．4）岁；采用单纯K-L入路治疗。比较两组患者的术中结果及术后疗效，以及感染、坐骨神经损伤、异位骨化、股骨头缺血性坏死及创伤性关节炎等并发症的发生率。结果40例患者术后获平均29．7个月（18-59个月）随访。截骨组患者的手术时间【（248．2±123．2）min】显著短于对照组患者【（276．1±50．6）min】，术后骨折复位满意率（100．0％）显著高于对照组患者（90.5％），术后1年髋关节内旋（19．7°±3．5°）、外旋（216．10°4.3°）、外展40．5°±4．7°）活动度显著优于对照组患者（14．3°±6．0°、21．0°±7．20°、31．9°±10．8°），住院时间[（19．0±7．1）d】显著长于对照组患者【（13．6±4．9）d】,差异均有统计学意义（P〈0．05）；术中出血量、输斑量略多于对照组，差异均无统计学意义（P〉0．05）。无一例患者出现医源性坐骨神经损伤和感染。末次随访时两组患者的Trendelenburg试验阳性率、髋关节功能及异位骨化、股骨头缺血性坏死、创伤性关节炎等并发症的发生率比较差异均无统计学意义（P〉0．05）。结论K-L入路联合DTFO治疗复杂髋臼骨折、尤其是累及髋臼顶和股骨头骨折时，手术暴露视野更大，可获得良好的骨折复位与功能恢复。除了术中出血量与输血量稍增加、住院时间延长外，未明显增加并发症。Objective To observe the short., mid- and long-term surgical complications of complex acetabulan fractures treated by the Kocher, Langenbeck （K-L） approach combined with digastric trochanteric flip osteotomy （DTFO） . Methods We reviewed the 40 cases of complex acetabular fracture that were treated at our department from December 2009 through December 2013. They were 34 men and 6 women, from 17 to 73 years of age （average, 47.6 years）. Of them, 19 were treated by K-L approach combined with DTFO, including 17 males and 2 females, with a mean age of 44. 7 ± 11.7 years. The other 21 controls were treated simply through the K-L approach, including 17 males and4 females, with a mean age of 42. 8 ± 14. 4 years. The 2 groups were compared in terms of intraoperstive results, postoperative outcomes and surgical complications like infection, sciatic nerve injury, heterotopic ossification, femoral avascular necrosis, and post-traumatic arthritis. Results The 40 cases were followed up for an average of 29.7 months （range, from 18 to 59 months）. The operation time for the DTFO group （248.2 ± 123. 2 min） was significantly shorter than that for the control group（276.1±50.6min）,the satisfactory reduction rate for the DTFO group（100.0%）was significantly higher than that for the control group（90.5%）,the hip intorsion （19.7°±3.5°）,hip extoraion（26.1°±4.3°）,and hip abduction（40.5°±4.7°）at one year postoperation in the DTFO group were significantly superior to those in the control group（14.3°±6.0°,21.0°±7.2°,31.9°±10.8°, respectively）, and the hospital stay for the for the DTFO group （19. 0 ±7.1 d） was significantly longer than that for the control group （13.6 ±4.9 d） （ P 〈 0.05）. The intraoperative bleeding and transfusion for the DTFO were insignificantly greater than those for the control group （ P 〉 0. 05）. Infection or iatrogenic sciatic nerve injury occurred in none of the patients. There were no significant differences between the 2 gro

关 键 词：髋臼 骨折 截骨术 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]