后方微创入路治疗髋臼后壁骨折的临床疗效  

Posterior minimally invasive approach for treatment of posterior wall acetabular fractures

作　　者：李文波 刘黎宏 时培晟 薛云 王伟 石杰 李闯兵 施显清 邓晓文 高秋明 LI Wenbo;LIU Lihong;SHI Peisheng;XUE Yun;WANG Wei;SHI Jie;LI Chuangbing;SHI Xianqing;DENG Xiaowen;GAO Qiuming(Department of Traumatic Orthopedics,the 940th Hospital of Joint Logistic Support Force of Chinese PLA,Lanzhou Gansu,730050,P.R.China;Graduate School,Gansu University of Traditional Chinese Medicine,Lanzhou Gansu,730000,P.R.China)

机构地区：[1]中国人民解放军联勤保障部队第九四〇医院创伤骨科,兰州730050 [2]甘肃中医药大学研究生院,兰州730000

出　　处：《中国修复重建外科杂志》2025年第2期134-139,共6页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：甘肃省重点研发计划项目(23YFFA0055);甘肃省临床医学研究中心建设项目(21JR7RA016)。

摘　　要：目的探讨后方微创入路治疗髋臼后壁骨折的临床疗效。方法回顾性分析2019年3月—2023年6月应用后方微创入路治疗的17例髋臼后壁骨折患者临床资料。男14例,女3例;年龄28~57岁,平均41岁。致伤原因:交通事故伤12例,高处坠落伤5例。合并髋关节后脱位3例,坐骨神经损伤2例。骨折按国际内固定研究协会/美国骨创伤协会(AO/OTA)分型,A1.1型11例,A1.2型6例。受伤至手术时间5~8 d,平均6.2 d。记录切口长度、术中出血量及手术时间;采用Matta评定标准评价后壁骨折复位质量;术后6个月及末次随访时采用改良Merle d’Aubign-Postel评分标准评价髋关节功能。结果17例均顺利完成手术。切口长度7~9 cm,平均8.3 cm,所有切口均Ⅰ期愈合;术中出血量200~350 mL,平均281 mL;手术时间45~70 min,平均57 min。2例术前存在坐骨神经损伤者,术后3个月坐骨神经功能完全恢复;余15例术后均未出现坐骨神经损伤症状。17例患者均获随访,随访时间14~27个月,平均19.5个月。术后1周根据Matta评定标准评价复位质量,获解剖复位12例、满意复位5例,满意率100%。术后患者骨折均愈合,愈合时间4~6个月,平均4.7个月。根据改良Merle d’Aubign-Postel评分标准,术后6个月髋关节功能评分13~18分,平均16.1分,其中优5例、良9例、可3例,优良率82.4%;末次随访时髋关节功能评分7~18分,平均13.7分,其中优3例、良9例、可3例、差2例,优良率70.6%。随访期间无感染、内固定失效、股骨头坏死发生,2例术后出现异位骨化。结论后方微创入路创伤小、手术时间短、出血少,不切断外旋肌,经臀中肌-梨状肌间隙、梨状肌-上孖肌间隙显露,可为髋臼后壁骨折提供足够的安全显露范围,是一种可靠的髋臼后侧备选手术入路。Objective To investigate the effectiveness of posterior minimally invasive approach in the treatment of posterior wall acetabular fractures.Methods The clinical data of 17 patients with posterior wall acetabular fractures treated with posterior minimally invasive approach between March 2019 and June 2023 were retrospectively analyzed.There were 14 males and 3 females with an average age of 41 years ranging from 28 to 57 years.The causes of injury were traffic accident in 12 cases and falling from height in 5 cases.There were 3 cases complicated with posterior hip dislocation and 2 cases complicated with sciatic nerve injury.According to AO/Orthopaedic Trauma Association(AO/OTA)classification,there were 11 cases of type A1.1 and 6 cases of type A1.2.The time from injury to operation was 5-8 days,with an average of 6.2 days.The incision length,intraoperative blood loss,and operation time were recorded.The quality of posterior wall fracture reduction were evaluated by Matta criteria,and hip function were evaluated by modified Merle d’Aubign-Postel score criteria at 6 months after operation and last follow-up.Results The operation was successfully completed in 17 cases.The length of incision ranged from 7 to 9 cm,with an average of 8.3 cm,and all incisions healed by first intention.The intraoperative blood loss ranged from 200 to 350 mL,with an average of 281 mL.The operation time ranged from 45 to 70 minutes,with an average of 57 minutes.Two patients had sciatic nerve injury before operation,and the sciatic nerve function recovered completely at 3 months after operation;the other 15 patients had no symptoms of sciatic nerve injury after operation.All the 17 patients were followed up 14-27 months,with an average of 19.5 months.At 1 week after operation,according to the Matta criteria,anatomical reduction was achieved in 12 cases and satisfactory reduction in 5 cases,with a satisfaction rate of 100%.According to the modified Merle d’Aubign-Postel scoring system,the hip function score was 13-18(mean,16.1)at 6 month

关 键 词：髋臼后壁骨折 手术入路 内固定 

分 类 号：R68[医药卫生—骨科学]