髋臼缘软组织修复联合骨折复位内固定技术在髋臼后壁骨折中的应用  

Application of acetabular margin soft tissue repair combined with fracture reduction and internal fixation in acetabular posterior wall fracture

作　　者：李永乐[1] 薛杨[1] 文华军 刘爱文 张朋[1] 李超[1] 张琰冰[1] 张华林 康锦 Li Yongle;Xue Yang;Wen Huajun;Liu Aiwen;Zhang Peng;Li Chao;Zhang Yanbing;Zhang Hualin;Kang Jin(Department of Orthopedics,Army 81th Group Army Hospital,Zhangjiakou,Hebei 075000,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院骨科,河北张家口075000

出　　处：《创伤外科杂志》2021年第10期753-756,共4页Journal of Traumatic Surgery

摘　　要：目的探讨髋臼缘软组织修复联合骨折复位内固定技术治疗髋臼后壁骨折的临床疗效。方法回顾性分析2018年1月—2019年12月中国人民解放军陆军第八十一集团军医院骨科收治髋臼后壁骨折患者26例(26髋),男性19例,女性7例;年龄23~65岁,平均48.3岁。致伤原因均为道路交通伤。按Letournel-Judet骨折分型均为单一后壁骨折;采用不离断外旋短肌群的改良K-L入路,选择骨盆重建锁定接骨板桥接支撑固定修复粉碎髋臼后壁骨折,结合髋臼缘、盂唇(臼唇)、韧带、关节囊等缝合固定,整体修复、重建后壁后侧关节结构。记录患者术后骨折复位质量、并发症发生情况及疗效等。结果患者术后均获10~24个月,平均16.5个月随访。术后骨折复位质量按Matta评分标准评定:优23例,良2例,差1例,优良率为96.2%。末次随访时根据改良Merle d’Aubigne&Postel评分标准评定患髋功能:优22例,良4例,优良率为100%。术后出现不同程度异位骨化5例,不影响关节功能。随访期间无一例患者发生切口液化、感染、骨性关节炎、股骨头缺血坏死、行走疼痛、跛行等并发症。结论髋臼缘软组织修复联合骨折复位内固定技术治疗髋臼后壁骨折具有并发症少的优点,骨折复位及功能恢复均满意。Objective To investigate the clinical effect of acetabular margin soft tissue repair combined with fracture reduction and internal fixation in the treatment of acetabular posterior wall fracture.Methods The data of 26 patients(26 hips)with acetabular posterior wall fracture admitted to the Department of Orthopedics,Army 81th Group Army Hospital from Jan.2018 to Dec.2019 were retrospectively analyzed,including 19 males and 7 females.Their ages ranged from 23 to 65 years,with an average of 48.3 years.All were road traffic injuries.According to Letournel-Judet fracture classification,all fractures were single posterior wall fracture.The modified K-L approach was adopted to repair the crushed posterior wall of the acetabulum by using the locking bone plate and bridge support for pelvic reconstruction.The acetabulum margin,labrum(labrum),ligament and joint capsule were combined to repair and reconstruct the posterior joint structure of the posterior wall.Postoperative fracture reduction quality,occurrence of complications and efficacy were recorded.Results All the 26 patients were followed up for 10 to 24 months(mean 16.5 months).The quality of postoperative fracture reduction was evaluated by Matta scoring standard:23 cases were excellent,2 cases were good,and 1 case was poor.The excellent and good rate was 96.2%.At the last follow-up,the function of the affected hip was assessed according to the modified Merle D'Aubigne&Postel score:22 cases were excellent and 4 cases were good,and the excellent and good rate was 100%.Five patients had different degrees of heterotopic ossification after operation,but the joint function was not affected.During the follow-up period,no patient had complications such as incision liquefaction,infection,osteoarthritis,avascular necrosis of femoral head,walking pain,claudication.Conclusion Acetabular margin soft tissue repair combined with fracture reduction and internal fixation in the treatment of acetabular posterior wall fracture has the advantages of few complications,satisfactory fra

关 键 词：髋臼骨折 骨折固定术 接骨板 

分 类 号：R687.3[医药卫生—骨科学]