全腹腔镜技术治疗骨盆与髋臼骨折的临床疗效  

Clinical effects of total laparoscopic technique in the treatment of pelvic and acetabular fractures

作　　者：庆思源 张少波 赵睿哲 李杰[2] 洪顾麒[1] 张宇[1] 胡军[1] 秦晓东[1] Qing Siyuan;Zhang Shaobo;Zhao Ruizhe;Li Jie;Hong Guqi;Zhang Yu;Hu Jun;Qin Xiaodong(Department of Orthopaedics,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Urology,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 [2]南京医科大学第一附属医院泌尿外科,南京京210029

出　　处：《中华骨科杂志》2024年第7期463-469,共7页Chinese Journal of Orthopaedics

摘　　要：目的接探讨全腹腔镜技术治疗骨盆与髋臼骨折的临床疗效。方法回顾性分析2017年4月至2023年8月南京医科大学第一附属医院骨科收治的骨盆和髋日骨折患者7例,男5例、女2例,年龄(43.9+9.9)岁(范围27~56岁)。骨盆骨折1例,Tile分型B3型;髋臼骨折6例,Letournel分型横形2例、双柱1例、横形+前柱1例、前柱1例、"T"形1例。致伤原因:交通伤4例,高处坠落伤1例,摔伤1例,重物砸伤1例。记录患者的手术时间、术中出血量、血管、神经、膀胱、直肠等医源性损伤及术后并发症发生率。采用Matta影像学标准评估骨折的复位质量,采用改良的Merled'Aubigne-Postel评分评价髋关节功能。结果7例患者均顺利完成手术并获得随访,随访时间为12.0(7.0,72.0)个月(范围7~77个月)。手术时间为(251.1±80.2)min(范围150.0~370.0min),术中出血量为100.0(50.0,300.0)ml(范围50~350ml)。术中无一例出现神经、血管、膀胱及直肠损伤。术后骨盆X线和CT均未见内固定物进入关节。7例患者中解剖复位5例,满意复位2例。1例髋白横形骨折的患者后柱存在轻度的分离移位,但髋关节面整体平整,未见明显台阶,未予固定。1例骨盆骨折患者骨盆前环粉碎,移位严重,术中未达解剖复位,但骨盆前环为非关节内骨折,采用双侧钢板对骨折端进行固定,术后骨盆前环形态及稳定性恢复良好。末次随访时Merled'Aubigné-Postel评分为18.0(17.0,18.0)分(范围17.0~18.0分),其中优4例、良3例。本组7例患者均获得临床愈合,愈合时间为2.5(2.5,3.0)个月(范围1.0~3.0个月)。无一例发生骨折延迟愈合或不愈合。末次随访时无一例出现内固定断裂、切口及内固定感染及深静脉血栓形成等并发症。结论全腹腔镜技术治疗骨盆与髋臼骨折术中出血量少、手术创伤小,临床疗效满意,可作为骨盆和髋臼骨折微创治疗的新选择。Objective To investigate the clinical efficacy of total laparoscopic technique in the treatment of pelvic and acetabular fractures.Methods A total of 7 patients with pelvic and acetabular fractures admitted to the First Affiliated Hospital of Nanjing Medical University from April 2017 to August 2023 were retrospectively analyzed.There were 5 males and 2 females,aged 43.9±9.9 years(range,27-56 years).There was 1 pelvic fracture(Tile B3)and 6 acetabular fractures,Letournel typing trans-verse in 2 cases,double column in 1 case,transverse combined anterior column in 1 case,anterior column in 1 case,and"T"shape in Icase.The causes ofinjury included trafic accident in 4 cases,falling from height in Icase,falling inIcase,and heavy object injury in 1 case.The operation time,intraoperative blood loss,iatrogenic injuries of blood vessels,nerves,bladder and rec-tum,and incidence of postoperative complications were recorded.Matta imaging criteria was used to evaluate the quality of frac-ture reduction,and the hip function was evaluated by modified Merle d'Aubigne-Postel score.Results All 7 patients were suc-cessfully operated and followed up for 12.0(7.0,72.0)months(range,7-77 months).The operation time was 251.1±80.2 min(range,150.0-370.0 min),and the intraoperative blood loss was 100.0(50.0,300.0)ml(range,50-350 ml).There was no nerve,blood vessel,bladder or rectum injury during operation.Postoperative pelvic X-ray and CT showed no internal fixation into the joint.Anatomic reduction was achieved in 5 cases and satisfactory reduction in 2 cases.One patient with a transverse acetabular fracture had a slight separation and displacement of the posterior column,but the acetabular articular surface was flat as a whole without obvious steps and was not fixed.One patient with pelvic fracture had a comminuted anterior pelvic ring with severe dis-placement and did not achieve anatomical repositioning intraoperatively,but the anterior pelvic ring was a non-intra-articular frac-ture,and the fracture ends were immobilized with bilate

关 键 词：骨盆 髋臼 骨折固定术 内 腹腔镜 

分 类 号：R687.3[医药卫生—骨科学]