经腹直肌旁腹膜外侧间隙入路治疗骨盆髋臼骨折  

Lateral-rectus approach for the treatment of pelvic and acetabular fracture

作　　者：唐文[1] 杨亚东[1] 赖光松[1] 刘氜[1] 张飞[1] 魏晓军[1] TANG Wen;YANG Ya-dong;LAI Guang-song;LIU Yang;ZHANG Fei;WEI Xiao-jun(The Orthopaedic Department of the First Affiliated Hospital of Gannan Medical University,Ganzhou Jiangxi 341000)

机构地区：[1]赣南医学院第一附属医院骨科,江西赣州341000

出　　处：《赣南医学院学报》2018年第7期639-642,共4页JOURNAL OF GANNAN MEDICAL UNIVERSITY

摘　　要：目的:探讨经腹直肌旁腹膜外侧间隙入路显露和治疗骨盆髋臼骨折的手术技巧和临床疗效。方法:回顾2012年10月~2017年12月我科收治并手术治疗的17例骨盆髋臼骨折患者的临床资料。按Tile分型:B型6例,C_2型9例,C_3型2例,均给予切开复位内固定术治疗。前方采用经腹直肌旁腹膜外侧间隙入路显露骨折,合并后柱或后壁骨折复位不理想者,则辅助后路K-L切口显露,记录手术时间、术中出血量、术前术后VAS评分、术后并发症、影像学评估骨折复位质量和骨折愈合时间,分析其治疗效果。结果:所有患者均于伤后6~15 d内完成手术,手术过程均顺利,平均手术时间119 min;平均术中出血量600 m L;平均手术切口长度10.3 cm。术后VAS疼痛评分:2例重度疼痛,15例中度疼痛。术中出现髂外静脉小破裂口损伤2例,给予缝合修复;1例后路切口出现术口感染,经拆线引流及换药后愈合;2例出现股外侧皮神经损伤。术后复查X线及CT三维重建显示骨折复位固定好;采用Matta标准评价骨折复位情况优良率89%;Merled'Aubigne评分评价患髋功能优良率为88%。所有患者均临床愈合,平均愈合时间12周。结论:经腹直肌旁腹膜外侧间隙入路治疗骨盆髋臼骨折,可以很好的从前方显露和复位固定一侧骨盆,尤其是有利于髋臼顶部四方区部分的手术操作,而且切口损伤和并发症较小。Objective： To explore the clinical effect and surgical skills of lateral-rectus approach for the treatment of pelvic and acetabular fracture. Method： From October 2012 to December 2017,17 patients with pelvic and acetabular fractures were surgically managed through lateral-rectus approach. According to Tile classification： there were 6 cases of type B,9 cases of type C2 and 2 Cases of C3. If the posterior column or posterior wall fracture was not ideal,then the posterior K-L incision was revealed. The operative time,intraoperative blood loss,VAS score,postoperative complications,and radiographic evaluation of the fracture reduction quality and fracture healing time were recorded for the therapeutic effect.Results： All the patients were completed the operation within 6 ~ 15 d after the injury,and the average operation time were 119 minutes. The average intraoperative blood loss was 600 m L; The average incision length was 10. 3 cm. Postoperative VAS pain score： 2 patients with severe pain,15 patients with moderate pain. 2 cases got small rupture on external iliac vein,which were repaired by suture. One case of posterior incision was infected,and the wound was healed after the drainage and the dressing. There were 2 cases of femoral cutaneous nerve injury. Postoperative X-ray and CT three-dimensional reconstruction showed that the fracture reduction was fixed. Matta standard was used to evaluate the optimal rate of fracture reduction by 89%. Merled＇Aubigné scoring rate was 88%. All patients were clinically healed,with an average healing time of 12 weeks. Conclusion： Lateral-rectus approach for the treatment of pelvic and acetabular fracture can be applied in open reduction and internal fixation on one side of the pelvis with less injury and complications.

关 键 词：骨盆髋臼骨折 内固定 骶髂关节 经腹直肌旁腹膜外侧间隙入路 

分 类 号：R683.3[医药卫生—骨科学]