髋臼横型骨折的单一手术入路选择  

Selection of single surgical approah for transverse acetabular fractures

作　　者：石永新 李富琴 谭文甫[2] 宋晖 陈斌[2] 

机构地区：[1]深圳市光明新区人民医院,广东518106 [2]南华大学附属第二医院骨科,湖南衡阳421001

出　　处：《创伤外科杂志》2017年第2期129-132,共4页Journal of Traumatic Surgery

摘　　要：目的比较髂腹股沟入路与Kocher-Langenbeck入路(K-L入路)两种单一手术入路治疗髋臼横型骨折的疗效,探讨两种单一手术入路在髋臼骨折治疗中的注意事项及并发症预防。方法回顾性分析笔者医院2006年6月~2014年7月,收治髋臼横型骨折27例,采用髂腹股沟单一入路治疗(髂腹股沟入路组)14例,男性9例,女性5例;年龄26~68岁,平均41.2岁;其中道路交通伤7例,高空坠落伤5例,重物砸伤2例。采用K-L单一入路治疗13例,男性10例,女性3例;年龄22~65岁,平均39.5岁;其中道路交通伤8例,高空坠落伤3例,重物砸伤2例。两组患者均有外伤史,经X线检查诊断为髋臼横行骨折。结果27例患者均获随访,髂腹股沟入路组随访时间12~49个月,平均21个月;K-L入路组15~57个月,平均26个月。髋臼骨折均愈合,髂腹股沟入路手术时间平均192min,较K-L入路组147min长,平均出血量622m L较K-L入路组529m L多。出现伤口愈合不良及股外侧皮神经损伤等早期并发症,K-L入路出现跛行及移位骨化等并发症,两组各出现股骨头缺血性坏死患者1例。结论髂腹股沟入路与Kocher-Langenbeck入路单一切口可以完成髋臼横型骨折的复位及内固定,规范熟练的操作可以降低及预防并发症。Objective To contrast the effect of ilioinguinal approach and Kocher-Langenbeck approach（KL） in the treatment of transverse acetabular fractures,and to investigate the points for attention and how to prevent complications. Methods Between Jun.2006 and Jul.2014,27 patients with transverse acetabular fractures were treated,with ilioinguinal approach in 14 patients（ 9 males and 5 females aged from 26-68 years,average 41. 2years）,and K-L approach in 13 patients（K-L group,10 males and 3 females aged between 22 and 65 year,average 39. 5 years）. All of them were suffered from trauma and diagnosed by X-ray. Results All of them were followed up. The average follow-up time was 21（12-49） months in ilioinguinal group and was 26（ 5-57） months in K-L group. All of the fractures healed. There was longer time of operation,more blood loss,more undesirable healing incisions and vastus lateralis nervous injury in the ilioinguinal group. There were complications of lameness and heterotopic ossification in K-L group. Vascular necrosis of femur head developped in one case in each group. Conclusion Either ilioinguinal approach or Kocher-Langenbeck approach could treat the transverse acetabular fractures.Normative and skillful operation could prevent complications.

关 键 词：髋臼横型骨折 髂腹股沟入路 K-L入路 

分 类 号：R683.3[医药卫生—骨科学]