多枚后柱螺钉技术在复合型髋臼骨折中的应用  

Application of multiple lag screws technique for posterior column in compound acetabular fractures

作　　者：洪顾麒[1] 庆思源 胡军[1] 秦晓东[1] HONG Guqi;QING Siyuan;HU Jun;QIN Xiaodong(Department of Orthopaedics,The First Affiliated Hospital to 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：《中华骨与关节外科杂志》2023年第7期606-611,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:探讨多枚后柱螺钉技术在复合型髋臼骨折中的应用效果及置钉技巧。方法:回顾性分析2015年2月至2020年12月收治的128例复合型髋臼骨折患者的临床资料,男94例,女34例;年龄18~78岁,平均(51.5±12.8)岁。手术均采用改良髂股两窗入路手术,后柱骨折置入2枚或以上螺钉固定。统计所有患者的一般资料、手术时间、术中出血量、骨折愈合时间、复位情况、髋关节功能、并发症情况等。结果:所有患者获得20~90个月随访,平均(43.9±17.0)个月;手术时间为60~440 min,平均(140±56)min;术中出血量为100~800 mL,平均(329±142)mL;骨折愈合时间为8~18周,平均(12.8±2.0)周;骨折复位75例解剖复位,46例满意复位,7例复位差,解剖复位率为58.6%,满意以上复位率为94.5%。末次随访时髋关节功能优62例,良53例,中10例,差3例,优良率89.8%。并发症方面,股外侧皮神经损伤45例(35.2%),内固定失效2例(1.6%),术后异位骨化3例(2.3%),无感染、腹腔脏器损伤等其他并发症。结论:经单一前方入路治疗复合型髋臼骨折时,多枚后柱拉力螺钉固定的总体效果满意。对于部分复杂病例,采用3枚拉力螺钉或结合阻挡螺钉固定临床效果更佳。Objective:To explore the outcomes of multiple lag screws for posterior column in compound acetabular fractures and the technique to set these screws.Methods:A retrospective analysis of 128 patients with compound acetabular fractures admitted to hospital from February 2015 to December 2020 were conducted including 34 females and 94 males with the mean age of(51.5±12.8)years(range,18-78 years).All patients were operated through the modified iliofemoral approach and fixed by two and more lag screws for posterior column.The general data of the patients,the operation time,intraoperative bleeding,fracture healing time,reduction,hip function and complications were recorded and analyzed.Results:All patients were followed up for 20-90 months with the average of(43.9±17.0)months;The operation time was ranged from 60 to 440 min with the mean of(140±56)min;Intraoperative blood loss was ranged from 100 to 800 mL with the mean of(329±142)mL;The fracture healing time was ranged from 8 to 18 weeks with the mean of(12.8±2.0)weeks;Anatomical reduction was achieved in 75 patients,satisfactory reduction in 46 patients,poor reduction in 7 patients,the rate of anatomical reduction was 58.6%,and the rate of satisfactory and anatomical reduction was 94.5%.At the last follow-up,hip joint function was excellent in 62 patients,good in 53 patients,accepable in 10 patients and poor in 3 patients with the excellent and good rate of 89.8%.In terms of complications,there were 45 cases(35.2%)of lateral femoral cutaneous nerve injury,2 cases(1.6%)of internal fixation failure,3 cases(2.3%)of ectopic ossification,and no infection or injury of abdominal organs after operation.Conclusions:In the treatment of compound acetabular fractures through a single anterior approach,using lag screws to fix the posterior column have satisfactory clinical outcomes.For some complicated cases,3 lag screws or combined with blocking screws to fix the posterior column fracture of acetabulum may be a better choice.

关 键 词：髋臼骨折 手术入路 拉力螺钉 骨折固定术 内 

分 类 号：R683.3[医药卫生—骨科学]