腹直肌外侧入路钢板结合后柱拉力螺钉固定治疗涉及后柱的髋臼骨折  

Surgical treatment of complex acetabular fractures through the lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws

作　　者：刘家国[1] 尚锋[1] 罗斌[1] 杨健[1] 熊为[1] 张劲松[1] 赵猛[1] Liu Jiaguo;Shang Feng;Luo Bin;Yang Jian;Xiong Wei;Zhang Jingsong;Zhao Meng(Department of Orthopaedics and Trauma,Taihe Hospital,Hubei University of Medicine,Shiyan 442000,Hubei,China)

机构地区：[1]湖北医药学院附属太和医院创伤骨科,十堰442000

出　　处：《中华创伤骨科杂志》2019年第6期490-497,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家卫生计生委重大疾病防治科技行动计划创伤修复专项项目(ZX-01-C2016155);十堰市科技局引导性科研项目(17Y16).

摘　　要：目的探讨腹直肌外侧入路钢板结合后柱拉力螺钉固定治疗涉及后柱的髋臼骨折的近期疗效。方法回顾性分析2014年1月至2018年4月期间湖北医药学院附属太和医院创伤骨科收治且获得随访的29例涉及后柱的髋臼骨折患者资料。男22例,女7例;年龄为19~72岁,平均41.7岁。髋臼骨折按Letournel-Judet分型:横形骨折4例,T形骨折7例,双柱骨折15例,前方伴后半横形骨折3例。所有患者均采用腹直肌外侧入路,前柱骨折应用重建钢板结合螺钉固定,后柱骨折采用顺行拉力螺钉固定。记录患者的手术时间、术中出血量、骨折复位质量、骨折愈合时间、患髋功能及并发症的发生情况等。结果本组患者的手术时间为50~140min,平均85min;术中出血量为150~1100mL,平均315mL。术后骨折复位质量根据Matta评分标准评定:优21例,良7例,差1例,优良率为96.6%。29例患者术后获平均16.2个月(6~30个月)随访。骨折愈合时间平均为11周(7~13周)。末次随访时根据改良Merled' Aubigne& Postel评分系统评定患髋功能:优20例,良7例,可2例,优良率为93.1%。1例患者术中发现髂外动脉血管痉挛。随访期间无一例患者发生感染、深静脉血栓形成、异位骨化、骨关节炎及股骨头缺血性坏死等并发症。结论采用腹直肌外侧入路钢板结合后柱拉力螺钉固定治疗涉及后柱的髋臼骨折可取得满意的临床效果。该入路对方形区的显露及顺行后柱拉力螺钉的置入有明显优势。Objective To evaluate the surgical treatment of complex acetabular fractures through the lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws. Methods Between January 2014 and April 2018, 29 patients were surgically treated for complex acetabular fractures at Department of Orthopaedic and Trauma, Taihe Hospital. They were 22 males and 7 females, aged from 19 to 72 years(mean, 41.7 years). According to the Letournel-Judet classification, there were 4 transverse fractures, 7 T-shape fractures, 15 both column fractures and 3 anterior plus posterior hemitransverse fractures. In all the patients, the lateral-rectus approach was adopted;their anterior column fractures were fixated with pelvic reconstructive plate and screws and their posterior column fractures with antegrade lag screws. The operation time, intraoperative bleeding, fracture reduction, fracture union time, function of the affected hip and complications were recorded. Results The operation time ranged from 50 to 140 min, averaging 85 min;the volume of intraoperative bleeding ranged from 150 to 1,100 mL, averaging 315 mL. By the Matta criteria, the reduction was rated as excellent in 21 cases, as good in 7 and as poor in one, giving an excellent to good rate of 96.6%. The average follow-up was 16.2 months (from 6 to 30 months) for the 29 patients. Their fractures got united after an average of 11 weeks (from 7 to 13 weeks). According to the Merle d'Aubigne& Postel scoring system at the last follow-up, the function of the affected hip was excellent in 20 cases, good in 7 and fair in 2, yielding an excellent to good rate of 93.1%. There was one case of vasospasm of external iliac artery. No such complications were observed by follow-up as infection, deep venous thrombosis, heterotopic ossification, osteoarthritis or avascular necrosis of the femoral head. Conclusions The lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws is a suitable surgical treatment for complex

关 键 词：髓臼 骨折 骨折固定术 内 骨钉 手术入路 

分 类 号：R687.3[医药卫生—骨科学]