经腹直肌外侧入路治疗老年骨盆脆性骨折  

Treatment of pelvic fragility factures in the elderly patients via lateral-rectus approach

作　　者：李涛 詹潇锐 郑秋宝 麦奇光 杨诚 黄海 王华 廖坚文 樊仕才 Li Tao;Zhan Xiaorui;Zheng Qiubao;Mai Qiguang;Yang Cheng;Huang Hai;Wang Hua;Liao Jianwen;Fan Shicai(Department of Traumatic Surgery,Center for Orthopaedics,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南方医科大学第三附属医院骨科医学中心创伤骨科,广州510630

出　　处：《中华骨科杂志》2021年第19期1396-1403,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81772428,82072411);南方医科大学临床研究启动计划(LC2016ZD032);。

摘　　要：目的探讨经腹直肌外侧切口入路治疗老年骨盆脆性骨折的手术方法及临床疗效。方法回顾性分析2011年1月至2019年12月采用经腹直肌外侧切口入路显露、复位,骨盆重建钢板和通道螺钉固定治疗30例老年骨盆脆性骨折患者资料,男9例,女21例;年龄60~87岁,平均72.5岁;车祸伤5例,高处坠落伤8例,摔伤17例;老年骨盆脆性骨折的FFP分型:Ⅱc型6例(6/30,20%),Ⅲ型22例(22/30,73.33%,其中Ⅲa型13例,Ⅲb型7例,Ⅲc型2例),Ⅳa型2例(2/30,6.67%):合并同侧髋臼骨折2例,合并高血压、冠心病、糖尿病等内科疾病17例,均未合并四肢骨折。手术均采用单一腹直肌外侧切口入路,于腹膜后显露,结合下肢牵引复位骨盆前、后环骨折,直视结合X线验证骨折移位基本复位后,后环行重建钢板和(或)骶髂螺钉固定,前环用重建钢板或INFIX架固定。采用Matta的X线复位评估标准评价骨折复位质量,采用Majeed评分评价骨盆骨折术后功能。结果30例患者均顺利完成手术,受伤至手术时间5~20 d,平均9.9 d;手术时间35~150 min,平均73.5 min;术中出血量220~2400 ml,平均586.7 ml;术中直视下复位骨折顺利,X线透视显示骨折复位良好,钢板、螺钉位置满意。术后X线片及CT扫描均显示骨盆环结构复位良好,按照Matta的X线复位评估标准,优18例、良6例、可4例、差2例,优良率80%(24/30);所有患者均获得随访,随访时间6~24个月;骨折均愈合,愈合时间2~5个月,平均3.5个月。末次随访时,Majeed评分(86.1±6.11)分(范围66~92分),其中优21例、良7例、可2例,优良率93.3%(28/30)。1例患者发生患侧下肢深静脉血栓,行溶栓后血栓消失;1例患者出现切口脂肪液化,经加强换药后伤口愈合;2例患者行INFIX架固定术后出现患侧大腿外侧麻木,给予对症治疗后症状好转;4例患者在随访中发现内固定螺钉松动,最终骨折愈合良好。结论经腹直肌外侧入路经盆内腹膜外显露整个半骨盆环,能�Objective To explore the surgical method and clinical efficacy of lateral-rectus approach(LRA)in the treatment of fragility fractures of the pelvis(FFP)in the elderly.Methods A retrospective study was conducted for elderly FFP patients from January 2011 to December 2019.All the pelvic fractures should be exposed and reduced through LRA and fixed with pelvic reconstruction plates and channel screws.Then,a total of 30 elderly patients were included in the study,including 9 males and 21 females,with an average age of 72.5 years(range,60-87 years).Fractures were caused by car accident in 5 cases,by falling from high places in 8 cases and by tumbling in 17 cases.According to the FFP classification,there were 6 cases of type IIc(6/30,20%),22 cases of type III(22/30,73.33%,of which 13 cases were type IIIa,7 cases were type IIIb,and 2 cases were type IIIc),2 cases of type IVa(2/30,6.67%).Among that,2 cases suffered ipsilateral acetabular fractures,17 suffered medical diseases such as hypertension,coronary heart disease,diabetes,etc.,and none suffered extremities fractures or other types of injuries.Surgical field was exposed retroperitoneally through LRA,combined with lower limb traction to reduce the anterior and posterior pelvis ring fractures.Then,the reductions were done in direct visions and verified through X-ray fluoroscopy.After that,the posterior ring was fixed with reconstruction plate and/or sacroiliac screws,and the anterior ring was fixed with reconstruction plate or INFIX.The quality of fracture reduction was evaluated by Matta score and the postoperative function was evaluated by Majeed score.Results All the 30 patients were surgical treated through LRA.The time from injury to operation was 5 to 20 days,with an average of 9.9 days.The operating time ranged from 35 to 150 min(mean,73.5 min)and the intraoperative bleeding ranged from 220 to 2400 ml(mean,586.7 ml).Fractures were successfully reduced under direct vision and the positions of the plates and screws were monitored through X-ray fluoroscopy during

关 键 词：老年人 骨盆 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]