经前方入路结合阻挡钢板螺钉治疗累及四边体髋臼骨折  

Anterior approach combined with blocking plates and screws in the management of acetabular fracture involving the quadrilateral area

作　　者：刘伟[1] 程建文[2] 唐士婷[3] 杨志[1] 谭桢[1] 石小荣 李育泉[1] 韦东磊 胡峰[1] 赵劲民[2] Liu Wei;Cheng Jianwen;Tang Shiting;Yang Zhi;Tan Zheri;Shi Xiaorong;Li Yuquan;Wei Donglei;Hu Feng;Zhao Jinmin(Department of Orthopedics,Second Affiliated Hospital of Guangxi Medical University,Nanning 530007,China;Department of Orthopedic Trauma and Hand Surgery.First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China;Department of Neurology.Second Affiliated Hopital of Guangxi Medical Universilty,Nanning 530007,China)

机构地区：[1]广西医科大学第二附属医院骨科,南宁530007 [2]广西医科大学第一附属医院创伤骨科手外科,南宁530021 [3]广西医科大学第二附属医院神经内科,南宁530007

出　　处：《中华创伤杂志》2021年第10期919-925,共7页Chinese Journal of Trauma

基　　金：国家自然科学基金(81960400);广西自然科学基金(2019GXNSFBA185024)。

摘　　要：目的探讨经前方入路结合阻挡钢板螺钉治疗累及四边体髋臼骨折的临床疗效。方法采用回顾性病例系列研究分析2017年1月至2019年1月广西医科大学第一、第二附属医院收治的16例累及四边体髋臼骨折患者临床资料,其中男12例,女4例;年龄21~66岁[(45.3±10.6)岁]。按照Letournel-Judet分型:双柱骨折9例,前方+后半横骨折6例,前柱骨折1例。采用髂腹股沟入路9例,腹直肌外侧入路7例,复位骨盆及髋臼骨折,均使用3.5 mm皮质骨全螺纹钉或钢板阻挡四边体骨折块内移。记录切口长度、手术时间、术中出血量。术后第2天,根据Matta影像学标准评价骨折复位情况。根据改良Merle D’Aubigne-Postel评价标准评估术后3、12个月髋关节功能。观察并发症情况。结果患者均获随访13~24个月[(16.1±2.9)个月]。髂腹股沟入路手术切口长12~26 cm[(18.6±4.0)cm];腹直肌外侧入路手术切口长8~15 cm[(10.7±2.3)cm]。手术时间107~215 min[(159.2±27.8)min],术中出血量200~2 300 ml[(853.1±489.7)ml]。术后第2天Matta影像学标准评价骨折复位质量:优9例,良7例。术后3个月改良Merle D’Aubigne-Postel评分为11~18分[(15.2±2.2)分],其中优4例,良7例,可4例,差1例,优良率为69%;术后12个月改良Merle D’Aubigne-Postel评分为13~18分[(16.9±1.4)分],其中优7例,良8例,可1例,优良率为94%。术后12个月Merle D’Aubigne-Postel评分高于术后3个月Merle D’Aubigne-Postel评分(P<0.05)。切口脂肪液化、膀胱损伤、股外侧皮神经损伤及异位骨化各1例,无内固定物松脱、断裂等并发症。结论经前方入路结合阻挡钢板螺钉治疗累及四边体髋臼骨折,骨折复位满意,可有效防止髋臼四边体骨折移位,术后髋关节功能恢复良好,并发症少。Objective To investigate the clinical efficacy of anterior approach combined with blocking plates and screws in the management of acetabular fracture involving the quadrilateral area.Methods A retrospective case series analysis was performed lor 16 patients with acetabular fracture involving the quadrilateral area admitted to First and Second Affiliated Hospital of Guangxi Medical University from January 2017 to January 2019.There were 12 males and 4 females,with the age of 21-66 years[(45.3±10.6)years].According to Letournel-Judet classification,there were 9 patients with hi-column fracture,6 with anterior and posterior traverse fracture and 1 with anterior column fracture.A total of 9 patients were operated via the ilioinguinal approach and 7 via the lateral-rectus approach.Reduction and fixation of the pelvis and acetabulum were performed,using 3.5 mm cortical hone screws or plates to block the internal displacement of fracture in the quadrilateral body.The incision length,operation time and intraoperative blood loss were recorded.The quality of fracture reduction was assessed according to the Malta reduction criteria at postoperative 2 days and hip function by the modified Merle D^(+)Auhigne-Poslel score al postoperative 3 months and 12 months.Postoperative complications were observed.Results All patients were followed up for 13-24 months[(16.1±2.9)months].The ilioinguinal approach and lateral-rectus approach showed surgical incision of 12-26 cm [(18.6±4.0)cm]and 8-15cm[(10.7±2.3)cm],respectively.The operation time was 107-215 minutes[(159.2±27.8)minutes]and the intraoperative blood loss was 200-2,300 ml[(853.1±489.7)ml].According to Matta reduction criteria,the results were excellent in 9 patients and good in 7.Three months after operation,the modified Merle D^(+)Auhigne-Postel score was 11-18 points[(15.2±2.2)points],which shovved the results were excellent in 4 patients,good in 7,fair in 4 and poor in 1,wilh the excellent and good rate of 69%.Twelve months after operation,the modified Merle D^(+)Aub

关 键 词：髋臼 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]