腹直肌外侧入路双钢板固定治疗累及四边体的髋臼双柱骨折  

The double-plate fixation with lateral rectus abdominis approach for treatment of the double-column acetabular fractures involving the quadrilateral area

作　　者：谢盼盼[1] 黄淑明[1] 兰树华[1] 吴泉州[1] 叶方[1] 叶积飞[1] XIE Pan-pan;HUANG Shu-ming;LAN Shu-hua;WU Quan-zhou;YE Fang;YE Ji-fei(Dept of Trauma Surgery,the Central Hospital of Lishui City,Lishui,Zhejiang 323000,China)

机构地区：[1]丽水市中心医院创伤外科,浙江丽水323000

出　　处：《临床骨科杂志》2023年第3期374-379,共6页Journal of Clinical Orthopaedics

基　　金：浙江省卫计委医药卫生科技计划项目(编号:2015KYB450);浙江省丽水市科技局公益计划项目(编号:2019GYX24、2021SJZC011)。

摘　　要：目的探讨腹直肌外侧入路双钢板固定治疗累及四边体的髋臼双柱骨折的疗效。方法采用腹直肌外侧入路双钢板固定治疗46例累及四边体的髋臼双柱骨折患者。记录术中出血量、手术时间、住院时间、并发症发生情况。采用Matta标准评定骨折复位质量。采用改良Merle D′Aubigne-Postel评分系统评定髋关节功能。结果1例失访(所有指标不予考察),其余45例获得随访,时间10~24个月。术中出血量150~510(392.3±103.7)ml,手术时间79~132(111.0±35.6)min,住院时间15~32(21.2±2.9)d。8例发生并发症,其中2例浅表创面皮肤感染,4例创伤性关节炎,1例股外侧皮神经损伤,1例异位骨化。骨折均愈合,时间6~12个月。术后X线和CT检查显示骨盆及髋臼骨折复位良好。术后10个月,采用Matta标准评价骨折复位质量:优28例,良9例,差8例,优良率为82.2%(37/45);采用改良Merle D′Aubigne-Postel评分系统评定髋关节功能:优25例,良10例,可7例,差3例,优良率为77.8%(35/45)。结论采用腹直肌外侧入路双钢板固定治疗累及四边体的髋臼双柱骨折,具有微创、术中暴露充分、复位固定良好、术中出血量少、并发症少的优点,患者可早期恢复功能锻炼。Objective To investigate the efficacy of double-plate fixation with lateral rectus abdominis approach for treatment of double-column acetabular fractures involving the quadrilateral area.Methods The 46 cases with double-column acetabular fractures involving the quadrilateral area were treated by double-plate fixation via lateral rectus abdominis approach.The intraoperative blood loss,operation time,length of stay and complications were recorded.Matta standard was used to evaluate the quality of fracture reduction.The improved Merle D′Aubigne-Postel scoring system was used to evaluate hip joint function.Results One case was lost to follow-up(all indicators would not be examined),and the other 45 cases were followed up for 10~24 months.The intraoperative blood loss was 150~510(392.3±103.7)ml,the operation time was 79~132(111.0±35.6)min,and the hospital stay was 15~32(21.2±2.9)d.Complications occurred in 8 cases,including 2 cases of superficial wound skin infection,4 cases of traumatic arthritis,1 case of lateral femoral cutaneous nerve injury and 1 case of heterotopic ossification.All fractures healed within 6~12 months.After operation,X-ray and CT showed good reduction of pelvic and acetabular fractures.At 10 months after operation,reduction quality assessed with Matta criteria:the result was excellent in 28 cases,good 9 cases and poor in 8 cases,with an excellent and good rate of 82.2%(37/45).According to the modified Merle D′Aubigne-Postel scoring system,the hip joint function was evaluated at 10 months after operation:excellent in 25 cases,good in 10,fair in 7 and poor in 3,the excellent and good rate was 77.8%(35/45).Conclusions For treatment of double-column acetabular fractures involving the quadrilateral area,the lateral rectus abdominis approach combined with double-plate fixation has the advantages such as minimally invasive,full exposure during operation,good reduction and fixation,less intraoperative blood loss,and fewer complications,and patients can do early functional exercise.

关 键 词：髋臼双柱骨折 四边体 双钢板固定 腹直肌外侧入路 

分 类 号：R683.3[医药卫生—骨科学] R687.32[医药卫生—外科学]