斜行髂坐钢板前路固定低位髋臼后柱骨折  

Anterior fixation with oblique-ilioischial plate for acetabular fractures of lower posterior column

作　　者：欧艺[1] 吴照祥[1] 陈仲[1] 陈戈[1] 赵航[1] 毕鑫[1] Ou Yi;Wu Zhaoxiang;Chen Zhong;Chen Ge;Zhao Hang;Bi Xin(Traumatology Center, The 2nd People＇ s Hospital of Yunnan Province, Kunming 650021, China)

机构地区：[1]云南省第二人民医院骨与创伤外科,昆明650021

出　　处：《中华创伤骨科杂志》2018年第5期382-388,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 探讨斜行髂坐钢板前路固定低位髋臼后柱骨折的临床效果. 方法 回顾性分析2016年8月至2017年7月期间采用手术治疗的7例伴有低位后柱骨折的髋臼骨折患者资料.男4例,女3例,年龄为45 ～ 62岁,平均48.6岁.致伤原因：交通伤4例,高处坠落伤3例.骨折按Le-tournel-Judet分型：横形骨折1例,T形骨折3例,前方伴后半横形骨折2例,双柱骨折1例.受伤至手术时间平均为7 d（6 ～ 19 d）.采用前方改良Stoppa入路或联合髂窝入路,如存在前柱骨折则先以钢板常规固定前柱,再于髂骨内侧至坐骨支铺设斜行髂坐钢板固定后柱骨折. 结果 本组患者的手术时间为1.0～3.2 h（平均2.1h）,术中出血量为200 ～ 500 mL（平均300 mL）.术后骨折复位质量按改良Matta标准评定：优5例,良1例,可1例.7例患者术后获7个月（6～9个月）随访.末次随访时按改良的Merle d＇Aubigne＆Postel功能评分系统评定患髋功能：优5例,良1例,可1例.本组7例患者骨折均获愈合,愈合时间平均为4.5个月（3～6个月）.随访期间无内固定失效、感染、异位骨化及神经血管损伤等并发症发生. 结论 经改良Stoppa入路斜行髂坐钢板前路固定低位髋臼后柱骨折具有固定可靠、损伤小、术中出血量少及并发症少等优点.Objective To investigate the effectiveness of anterior fixation with an oblique-ilioischial plate for acetabular fractures of lower posterior column.Methods A consecutive series of 7 patients were retrospectively reviewed who had been treated operatively from August 2016 to July 2017 for acetabular fractures of lower posterior column.They were 4 men and 3 women,aged from 45 to 62 years （average,48.6 years）.The injury was caused by a traffic accident in 4 cases and by falling from a height in 3.By the Letournel-Judet classification,there were one case of transverse fracture,3 cases of T-shaped fracture,2 cases of anterior ＋ posterior hemitransverse fracture and one case of associated both column fracture.The intervals from injury to operation ranged from 6 to 19 days （average,7 days）.All of them were treated by the modified Stoppa approach （or combined with an iliac fossa approach）.The anterior column was stabilized with a reconstruction plate for the iliac wing along the iliopectineal line to the pubis in all cases.The lower posterior column was fixated with a newly developed oblique-ilioischial plate running from the ilium to the ischial ramus.Operative time,intraoperative blood loss,reduction quality and postoperative function of the affected hip were recorded.Results The operative time for this cohort ranged from 1.0 to 3.2 h （average,2.1 h） and the intraoperative blood loss from 200 to 500 mL （average,300 mL）.The postoperative reduction was rated by the Matta＇s criteria as excellent in 5 cases,as good in one and as fair in one.This cohort was followed up for 7 months （from 6 to 9 months）.At the final follow-up,the hip function was rated by the modified Merle d＇Aubigne-Postel scale as excellent in 5 cases,as good in one and as fair in one.Fracture healing was achieved in all the patients after 3 to 6 months （average,4.5 months）.No implant failure,infection,heterotopic ossification or neurovascular injury occurred during the follow-up.Conclusion Anterior fixation with an obliqu

关 键 词：髋臼 骨折 骨板 骨折固定术 内 手术入路 

分 类 号：R687.3[医药卫生—骨科学]