改良髂股两窗入路与髂腹股沟入路复位内固定治疗复合髋臼骨折的疗效比较  

Efficacy comparison between modified two‑window iliofemoral approach and ilioinguinal approach for reduction and internal fixation of composite acetabular fracture

作　　者：洪顾麒[1] 庆思源 胡军[1] 方加虎[1] 吕天润[1] 陈群[1] 秦晓东[1] Hong Guqi;Qing Siyuan;Hu Jun;Fang Jiahu;Lyu Tianrun;Chen Qun;Qin Xiaodong(Department of Orthopedics,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210029

出　　处：《中华创伤杂志》2023年第2期145-152,共8页Chinese Journal of Trauma

摘　　要：目的比较改良髂股两窗入路与髂腹股沟入路复位内固定治疗复合髋臼骨折的疗效。方法采用回顾性队列研究分析2016年1月至2021年8月南京医科大学第一附属医院收治的160例复合髋臼骨折患者的临床资料,其中男117例,女43例;年龄15~78岁[(44.1±16.0)岁]。骨折Letournel分型:双柱骨折101例,前柱前壁伴后半横形骨折35例,“T”形骨折24例。80例采用改良髂股切口结合有限Pfannenstiel切口复位内固定(改良髂股两窗入路组),80例采用标准髂腹股沟入路复位内固定(髂腹股沟入路组)。观察骨折愈合情况;比较两组手术时间、术中出血量;术后1 d和术后6个月采用Matta评分标准评定骨折复位质量;末次随访时采用改良Merle d′Aubigne&Postel评分标准评价患髋关节功能;比较两组神经血管损伤、医源性膀胱损伤、异位骨化、股骨头坏死等并发症发生情况。结果患者均获随访12~78个月[(43.3±17.9)个月]。骨折均骨性愈合。改良髂股两窗入路组手术时间和术中出血量分别为150.0(123.8,180.0)min、600.0(500.0,787.5)ml,髂腹股沟入路组分别为190.0(150.0,240.0)min、700.0(562.5,887.5)ml(P均<0.01)。术后1 d和术后6个月两组骨折复位质量、末次随访时患髋关节功能及并发症发生情况等差异无统计学意义(P均>0.05)。结论与髂腹股沟入路相比,改良髂股两窗入路复位内固定治疗复合髋臼骨折在骨折复位效果、术后患髋关节功能及并发症发生率相近的情况下,可明显缩短手术时间,减少术中出血量等。Objective To compare the effect of reduction and internal fixation of composite acetabular fracture with the modified two‑window iliofemoral approach and ilioinguinal approach.Methods A retrospective cohort study was used to analyze the clinical data of 160 patients with composite acetabular fracture admitted to First Affiliated Hospital of Nanjing Medical University from January 2016 to August 2021,including 117 males and 43 females,aged 15‑78 years[(44.1±16.0)years].According to the Letournel classification system,there were 101 patients with both-column fracture,5 with anterior wall/column combined with posterior semi-transverse fracture and 24 with T-shaped fracture.A total of 80 patients were treated using the modified iliofemoral incision combined with limited Pfannstiel incision(modified two‑window iliofemoral approach group)and the other 80 patients were treated using the ilioinguinal approach(ilioinguinal approach group).The fracture healing was observed.The operation time and intraoperative bleeding volume were compared between the two groups.The quality of fracture reduction was evaluated by Matta scoring standard at 1 day and 6 months after operation.The modified Merle d′Aubigne&Postel scoring standard was used to evaluate the function of the affected hip joint at the last follow‑up.The incidence of complications such as neurovascular injury,iatrogenic bladder injury,heterotopic ossification and femoral head necrosis were compared between the two groups.Results All patients were followed up for 12‑78 months[(43.3±17.9)months],with bony union of the fracture.The operation time and intraoperative bleeding volume in modified two‑window iliofemoral approach group were 150.0(123.8,180.0)minutes and 600.0(500.0,787.5)ml when compared to 190.0(150.0,240.0)minutes and 700.0(562.5,887.5)ml in ilioinguinal approach group(all P<0.01).There was no significant difference between the two groups in the quality of fracture reduction at 1 day and 6 months after operation,function of hip joint at the la

关 键 词：髋臼 骨折固定术 内 手术入路 

分 类 号：R687.3[医药卫生—骨科学]