单一入路的"三连四接法"在髋臼高位双柱骨折治疗中的应用  

The three-connections and four-screwings technique via a single ilioinguinal approach for treatment of high double column acetabular fractures

作　　者：刘惠军 周迁迁 熊湘龙 张斌 贵仲南 王波 汤亚军 向鹏 石青 Liu Huijun;Zhou Qianqian;Xiong Xianglong;Zhang Bin;Gui Zhongnan;Wang Bo;Tang Yajun;Xiang Peng;Shi Qing(Trauma Ward 2,Department of Orthopedics and Traumatology,The First Hospital of Traditional Chinese Medicine of Changde,Changde 415000,China)

机构地区：[1]常德市第一中医医院骨伤科创伤二病区,常德415000

出　　处：《中华创伤骨科杂志》2024年第3期262-266,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨"三连四接法"经单一髂腹股沟入路手术治疗髋臼高位双柱骨折的临床疗效。方法回顾性分析2017年6月至2020年6月期间常德市第一中医医院骨伤科创伤二病区收治的42例髋臼高位双柱骨折患者资料。男19例,女23例;年龄(42.7±25.6)岁;致伤原因:交通伤29例,高处坠落伤12例,摔伤1例;受伤至手术时间为(4.5±2.1)d。所有患者采用"三连四接法"经单一髂腹股沟入路手术治疗,即采用3种途径将前柱与主骨连接固定,4种途径中的2种或3种将后柱与已复位的前柱连接固定。记录患者的手术时间、术中出血量、骨折复位质量、骨折愈合时间、末次随访时髋关节功能及随访期间并发症的发生情况等。结果本组患者的手术时间为(150.0±30.5)min,术中出血量为(300.0±50.0)mL。术后髋臼骨折复位标准按照Matta评分标准评定:优34例,良6例,可2例,优良率为95.2%(40/42)。1例患者术后出现脂肪液化,伤口渗液,予引流换药后愈合。42例患者术后获(15.0±3.4)个月随访,骨折均获愈合,愈合时间为(11.0±2.0)个月。末次随访时采用改良Merle d’Aubigné & Postel评分系统[8]评定髋关节功能:优33例,良6例,可3例,优良率为92.9%(39/42)。结论经单一髂腹股沟入路应用"三连四接法"治疗髋臼高位双柱骨折,对髋臼骨折进行拉力螺钉加压、中和钢板保护,可获得良好的复位与固定,患者能早期进行功能锻炼,疗效良好。Objective To investigate the clinical efficacy of three-connections and four-screwings technique in the treatment of high double column acetabular fractures through a single ilioinguinal approach.Methods A retrospective study was conducted to analyze the data of 42 patients who had been treated for high double column acetabular fractures from June 2017 to June 2020 at Trauma Ward 2,Department of Orthopedics and Traumatology,The First Hospital of Traditional Chinese Medicine of Changde.There were 19 males and 23 females with an age of(42.7±25.6)years.29 injuries were due to a traffic accident,12 ones to fall from a height,and one to fall.The time from injury to operation was(4.5±2.1)days.All the patients were treated by the three-connections and four-screwings technique through a single ilioinguinal approach.Briefly,the anterior column was connected and secured to the main bone using 3 routes,and the posterior column was attached and fixated to the anterior column reset using 2 or 3 of the 4 screwings.The operation time,intraoperative blood loss,fracture reduction quality,fracture healing time,hip function at the last follow-up and complications during the follow-up were recorded.Results For this cohort,the operation time was(150.0±30.5)min,and intraoperative blood loss(300.0±50.0)mL.According to the Matta scale for postoperative acetabular fracture reduction,34 cases were excellent,6 cases good,and 2 cases acceptable,with an excellent and good rate of 95.2%(40/42).After operation one patient had fat liquefaction and wound exudation which responded to drainage and dressing change.The 42 patients were followed up for(15.0±3.4)months.All fractures healed after(11.0±2.0)months.By the modified Merle d'Aubigné&Postel scoring system,the hip function was evaluated at the last follow-up as excellent in 33 cases,as good in 6 cases,and as fair in 3 cases,yielding an excellent and good rate of 92.9%(39/42).Conclusions In the treatment of high double column acetabular fractures,the three-connections and four-screwings

关 键 词：髋臼 骨折 骨折固定术 三连四接法 髂腹股沟入路 

分 类 号：R687.3[医药卫生—骨科学]