激光辅助轴位透视经皮螺钉固定治疗髋臼前柱骨折  

Treatment of acetabular anterior column fracture with percutaneous screw fixation with laser-assisted axial fluoroscopy

作　　者：胡居正[1] 石展英[1] 王仁崇[1] 吴昊[1] 谢友[1] 毛春华[1] 刘搏宇 唐经励[1] 朱成明[1] 周丹[1] 李兵[1] Hu Juzheng;Shi Zhanying;Wang Renchong;Wu Hao;Xie You;Mao Chunhua;Liu Boyu;Tang Jingli;Zhu Chengming;Zhou Dan;Li Bing(Trauma Center,Fourth Affiliated Hospital of Guangxi Medical University,Liuzhou Workers Hospital,Liuzhou 545000,China)

机构地区：[1]广西医科大学第四附属医院,柳州市工人医院创伤中心,545000

出　　处：《中华骨科杂志》2020年第5期302-309,共8页Chinese Journal of Orthopaedics

基　　金：广西科技计划项目-广西重点研发计划(桂科AB17129001);柳州市科学研究与技术开发计划课题(2017BH202308);广西医科大学青年科学基金(GXMUYSF201544)。

摘　　要：目的探讨激光辅助轴位透视经皮螺钉固定治疗髋臼前柱骨折的可行性及近期临床疗效。方法回顾性分析2017年1月至2018年12月采用激光辅助轴位透视经皮螺钉固定治疗的髋臼前柱骨折患者20例(22髋),男11例,女9例;年龄(42.1±3.2)岁(范围,24~68岁)。单侧髋臼前柱骨折7例,双侧髋臼前柱骨折2例(4髋),髋臼前柱合并同侧骶骨骨折7例,髋臼前柱合并骶髂关节损伤4例。髋臼前柱骨折Nakatani分区:Ⅰ区3髋,Ⅱ区6髋,Ⅲ区13髋。受伤至手术时间为5 d(范围,3~11 d)。髋臼前柱骨折均采用激光辅助轴位透视经皮螺钉固定,合并骶骨骨折或骶髂关节损伤患者采用Starr架辅助复位后以经皮骶髂螺钉固定。记录患者髋臼前柱螺钉置入的手术时间、术中透视次数及术中出血量。术后采用Matta评分标准评定骨折复位质量,末次随访时根据改良Merle D'Aubignéand Postel评分系统评定髋关节功能。结果22髋的前柱螺钉置入手术时间为(22±10)min(范围,20~40 min),术中透视次数(30±8)次(范围,21~45次),术中出血量(20±5)ml(范围,10~40 ml)。20例患者术后均获得随访,随访时间(14±3.1)个月(范围,12~18个月)。骨折复位质量:解剖复位18髋,满意复位2髋,不满意复位2髋,优良率为91%(20/22)。骨折愈合时间为(13±2.2)周(范围,11~16周)。末次随访时髋关节功能:优18髋,良3髋,可1髋,优良率为95%(21/22)。1例术后前柱螺钉皮肤切口出现渗出,1例术中损伤臀上动脉分支导致术后臀部皮下瘀斑及血肿。随访期间无一例发生内固定物松动、断裂或骨折再次移位等并发症。结论采用激光辅助轴位透视经皮螺钉固定治疗髋臼前柱骨折,操作简便,手术时间短,不易损伤重要血管及神经,术中出血量少,近期疗效满意。Objective To investigate the feasibility and clinical efficacy of percutaneous screw fixation for acetabular anterior column fracture with laser-assisted axial fluoroscopy.Methods Data of 20 patients(22 sided)with acetabular anterior column fracture treated by percutaneous screw fixation with laser-assisted axial fluoroscopy from January 2017 to December 2018 were retrospectively analyzed.There were 11 males and 9 females with an average of 42.1±3.2 years(range,24-68 years).There were 7 cases of unilateral acetabular anterior column fracture,2 cases of bilateral acetabular anterior column fracture(4 sides),7 cases of anterior column with ipsilateral sacral fracture,and 4 cases of anterior column with sacroiliac joint injury.There were 3 hips of Area I,6 Area II,13 Area III of acetabular anterior column fractures according to Nakatani partition.The time from injury to surgery was 5 days(range,3-11 days).All patients with acetabular anterior column fractures were fixed by percutaneous screw fixation with laser-assisted axial fluoroscopy,and patients with sacral fracture or sacroiliac joint injury were fixed by percutaneous sacroiliac screws with Starr frame-assisted reduction.The time of operation,the number of intraoperative fluoroscopy and the amount of intraoperative bleeding were recorded.Matta scoring criteria were used to assess fracture reduction quality,and hip function was assessed at the last follow-up according to the modified Merle D'Aubignéand Postel scoring system.Results The average operative time was 22±10 min(range,20-40 min)with an average times of intraoperative fluoroscopy of 30±8 times(range,21-45 times),and the amount of intraoperative blood loss was 20±5 ml(range,10-40 ml).20 patients were followed up after operation for a period of 14±3.1 months(range,12-18 months).The quality of postoperative fracture reduction was assessed according to the Matta acetabular fracture reduction criteria:anatomical reduction in 18 hips,satisfactory reduction in 2 hips,unsatisfactory reduction in 2 hips,w

关 键 词：髋臼 骨折 骨折固定术 内 激光 

分 类 号：R687[医药卫生—骨科学]