手术治疗严重复杂髋臼骨折78例

目的探讨手术治疗严重复杂髋臼骨折的临床疗效。方法严重复杂髋臼骨折78例按照Letournel分型,复合型骨折78例,其中“T”形骨折16例,横形伴后壁骨折22例,后柱伴后壁骨折9例,前柱伴后半横形骨折2例,双柱骨折29例。手术入路:采用Kocher-Langenbeck(K-L)入路22例,髂腹股沟入路25例,扩展髂股入路7例,联合入路(髂腹股沟加K-L入路)24例。结果按Matta评定法,本组优26例,良35例,尚可15例,失败2例,优良率78.2%。结论正确分析骨折移位和类型、选择适当的手术路径是提高髋臼骨折治疗效果的重要保证,手术疗效与骨折复位质量密切相关。     

髂腹股沟入路手术治疗髋臼骨折

目的 探讨应用髂腹股沟入路手术治疗髂臼骨折的实用性。方法 应用该切口手术治疗髋臼前方骨折18例，采用髋臼钢板或钢丝张力带固定，结果 12例达解剖复位，5例满意复位，平均随访3年，髋关节功能优良率77.8%。结论 髂腹股沟入路是手术治疗髋臼前柱骨折的较理想的入路。     

复杂髋臼骨折手术入路的设计及评估

髋臼部位解剖特殊,骨折类型复杂,特别是复杂髋臼骨折,恰当的手术入路对于术中满意的显露、复位、固定尤为重要。髋臼骨折的手术入路有许多种,根据其适用范围可分为：前侧入路(髂股入路、髂腹股沟入路及其改良入路)、后侧入路(K-L入路、改良K-L入路)、扩展入路和前后联合入路(K-L入路 髂腹股沟入路或髂股入路)；根据其特点可分为：经典入路(K-L入路、髂腹股沟入路、髂股入路)、扩展或改良入路、特殊入路和前后联合入路。本文总结了各种髋臼骨折的手术病例,简要概述了各种手术入路的优缺点,并提出相应的优化措施。     

髋臼周围截骨三种手术入路比较

目的比较髂腹股沟入路、改良髂股入路、髂股双切口入路进行髋臼周围截骨手术的优缺点。方法自2010年2月至2011年7月对95例101髋分别采用上述三种不同手术入路进行髋臼周围截骨内固定术,通过回顾性研究,在年龄、性别、病变程度相似的情况下,比较不同手术入路髋臼周围截骨手术的手术时间、术中出血量、异体输血量、手术相关早期并发症等的差异。结果髂腹股沟入路手术时间较短、术中出血量较多（P〈0.05）;髂股双切口虽然术中出血量较少（P〈0.05）,但相关并发症较多;改良髂股入路虽手术时间稍延长,但术中出血少（P〈0.05）、相关并发症较少。结论采用改良髂股入路进行髋臼周围截骨手术有较明显的优势。     

经腹直肌外侧入路与髂腹股沟入路手术治疗骨盆髋臼骨折的疗效比较

目的比较腹直肌外侧入路与髂腹股沟入路手术治疗骨盆髋臼骨折的临床疗效。方法纳入自2017-12—2018-12诊治36例的骨盆髋臼骨折,行切开复位内固定手术,18例采用腹直肌外侧入路(腹直肌外侧入路组),18例采用髂腹股沟入路(髂腹股沟入路组)。结果 36例均获得随访,随访时间平均18(7~32)个月。腹直肌外侧入路组术中出现1例髂外静脉损伤,1例腹膜损伤,1例闭孔神经损伤。髂腹股沟入路组出现2例股外侧皮神经损伤,2例血管栓塞,2例腹股沟疝。与髂腹股沟入路组比,腹直肌外侧入路组手术时间较短,术中出血量较少,差异有统计学意义(P <0.05)。2组骨折复位质量、术后6个月髋关节功能比较差异无统计学意义(P>0.05)。结论与髂腹股沟入路相比,腹直肌外侧入路手术治疗骨盆髋臼骨折可充分显露四边体骨折,便于骨折复位及钢板置入,进而缩短手术时间并减少术中出血量。     

髋臼骨折的手术治疗

目的：评价手术治疗髋臼移位骨折的效果。方法：总结对38例有移位髋臼骨折手术治疗的经验。根据骨折类型选用髂腹股沟入路、Kocher-Langenbeck入路、延长髂股入路，复位后用骨盆钢板和可吸收钉固定。结果：38例中22例（57.9%），完全复位，8例（21.05%）满意复位，8例（21.05%）复位不满意。30例获得随访，平均随访时间2.5年。根据Matta评分标准：优9例（30％),良13例（37％），一般6例（20％）。差4例（13％）。结论：对于髋臼骨折，联合应用三个方向的X片和CT扫描，准确诊断，尽早予以解剖复位，牢固固定，骨折愈合后负重运动。     

对99例髋臼骨折内固定治疗的分析

从１９７２年１１月至１９９４年３月，４０１例髋臼骨折病人中的９９例经手术治疗并获随访、包括３０例双柱骨折，１３例横骨折伴后壁骨折，９例后壁有折，９例后柱骨折，９例前柱骨半前壁骨折，１３例Ｔ形骨折和１６例横骨折。平均随访时间为７年。外科手术入路的选择，后入路５３次，髂腹股沟入路２３次，延长的髂股骨入路１１次，放射状入路９次和结合性入路６次。     

髋臼骨折手术治疗的回顾性分析

目的 探讨髋臼骨折的诊断、手术方法及治疗效果. 方法 从1999年1月至2006年12月,共手术治疗髋臼骨折46例48髋,其中A型骨折18髋,B型骨折22髋,C型骨折8髋.手术采用髂腹股沟入路6髋,K-L入路27髋,前后联合入路(髂腹股沟+K-L入路)13髋,延长的髂股人路2髋. 结果 解剖复位32例(66.7%),复位满意11例(22.9%),复位不满意5例(10.4%).随访4个月～4年,平均2年5个月.按改良D'Aubigne和Postel评分标准评定关节功能:优26髋,良9髋,可9髋,差4髋,优良率为72.9%(35/48). 结论 术前CT三维重建对骨折准确分型和选择合理的手术入路具有重要作用;术前在骨盆标本上模拟手术并初步预弯重建钢板,对缩短手术时间、提高手术效果有很大帮助;术中对骨折在尽可能地解剖复位,并可靠内固定是取得良好疗效的基础.     

复杂髋臼骨折的手术治疗方法探讨

目的探讨复杂髋臼骨折的手术治疗方法及其并发症防治。方法对26例复杂髋臼骨折采用的手术入路分别为Kocher—Langenbeck入路（K—L入路）、髂腹股沟入路及前后联合入路。根据不同骨折类型采用重建钢板及拉力螺钉固定。结果经6～66个月随访，根据Matra评分髋关节功能：优9例，良11例，一般4例．差2例。结论复杂髋臼骨折术前正确分析骨折类型．选择合适的手术入路和内固定方法．早期手术是提高治疗效果的关键。     

严重粉碎性髋臼骨折的手术治疗

目的：探讨严重粉碎髋臼骨折手术治疗策略和方法。方法：47例复杂髋臼骨折采用重建钢板和拉力螺钉内固定，按照Letoumel分类，后柱合并后壁骨折5例，横形合并后壁骨折9例，T形骨折11例。双柱骨折合并后壁骨折16例，前柱合并后半横形骨折6例。合并髋脱位22例。K-L入路11例，髂腹股沟入路16例，延长髂股入路2例，双入路18例。结果：随访6～36个月，按照d‘Aubigne-Postel标准，关节功能优34例，良10例，可3例，优良率93．60％。深部感染1例，医源性坐骨神经损伤1例，静脉血栓1例，中重度骨关节炎2例，股骨头缺血坏死1例，异位骨化7例。结论：手术前明确骨折分类、手术时机适当、合适的入路和可靠的内固定及满意的复位是提高髋臼骨折治疗效果的关键。     

Acetabular fractures

Summary Each acetabular fracture means a huge intellectual and a demanding technical challenge for the surgeon on charge. Because the hip joint is situated within a complex threedimensional structure the diagnostics of its lesions are difficult. Three conventional X-ray views enable the recognition of a specific fracture type, computertomographic cuts give a detailed view on the type and the severity of the cartilage lesions, threedimensional reconstructions make a clear spatial imaging of the fracture configuration possible. These different radiological images are not superfluous, but complementary. Preoperative planning involves the choice of the approach and of the type of osteosynthesis. The Kocher-Langenbeck and the ilioinguinal approach are non-extensile approaches. They enable the internal fixation of the big majority of acute lesions. Each approach has its specific, well defined field of indications. Specific complications of the Kocher-Langenbeck approach are sciatic nerve palsy and periarticular ossifications. Complications of the ilioinguinal approach are damage to the iliac vessels and/or lymph vessels, to the lateral femoral cutaneous nerve and to the femoral nerve. Aseptic necrosis of the femoral head is a common complication of both approaches, but has to be differentiated from wear of the femoral head due to friction. Indications for the extended approaches are limited, their risks and complications are higher than in the non-extensile approaches. An active aftertreatment is only possible after a stable fracture fixation, the characteristics of physiotherapy are dependent on the type of approach. In a personal series of 225 operatively treated acetabular fractures, 128 were stabilized through a Kocher-Langenbeck approach. 103 of these patients could be reviewed after an average time of 25,9 months. 73,8 % of them had an excellent or good result in the classification of Merle d'Aubigne. 61 fractures were fixed through an ilioinguinal approach. 48 could be reviewed after a mean time of 23 months. 85,4 % obtained an excellent or good result in the functional scale of Merle d'Aubigne. These results are comparable with similar larger studies in the recent literature. The acetabular fracture in the elderly is a specific and rare type of lesion. When operated on quickly, open reduction and internal fixation can also give gratifying results. Alternative methods as primary or secondary total hip arthroplasty are at least as demanding for the patient and are combined with a high percentage of loosening of the acetabular component. The rarity and complexity of acetabular fractures asks for a specific teaching and learning with a experienced acetabular surgeon.      

单纯后入路与扩大髂腹股沟入路治疗Tile C型骨盆骨折的疗效分析

目的回顾性分析单纯后入路与扩大髂腹股沟入路切开复位内固定治疗Tile C型骨盆骨折的临床疗效。方法 2005年1月至2009年6月共收治27例Tile C型骨盆骨折患者,其中12例采用后入路切开复位后,重建接骨板固定后环,前环不予固定;15例采用扩大髂腹股沟入路重建接骨板固定。术后均予以定期随访,从手术时间、术中出血量、切口长度、下地时间、术后髋关节功能等方面对两组的临床疗效进行比较分析。结果全部患者均获得随访,随访时间为6～24个月,平均12.6个月。全部患者均骨性愈合;单纯后入路在手术时间、术中出血量及切口长度方面均优于扩大髂腹股沟入路,差异有统计学意义（P〈0.05）;比较下地时间及髋部功能,差异无统计学意义（P〉0.05）。结论单纯后侧入路与扩大髂腹股沟入路相比,具有创伤小、手术时间短等优点,可获得满意的临床效果。     

Iliumosteotomie bei Hüftgelenkluxationsfraktur mit posterior-inferiorer Gelenkfragmentdislokation

Open reduction and internal fixation is the treatment of choice for displaced acetabular fractures. The surgical approach depends on the fracture type, concomitant injuries, and general condition of the patient. The ilioinguinal approach provides a good exposure to the medial wall and is associated with an acceptable degree of surgical trauma. Exposure of the joint surface, however, is difficult when using the ilioinguinal approach.We report a case of a polytraumatized 39-year-old patient who sustained a posterior hip displacement and a two-column acetabular fracture. An osteotomy of the iliac ala was performed via an ilioinguinal approach to fragments of the acetabular surface that were displaced distally. Thereby, reposition of a craniolateral fragment was achieved without the need to extend the surgical approach or to perform a second incision.     

Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures: A systematic review and meta-analysis

Purpose: To compare the efficacy and safety of open reduction and internal fixation through ilioinguinal approach and Stoppa approach for the treatment of displaced acetabular fractures. Methods: Case-controlled trials (CCTs) published from January 2010 to August 2015 that compared the ilioinguinal approach and Stoppa approach in the management of displaced acetabular fractures were retrieved from the databases of Cochrane Library, Pubmed, CNKI, and so on. Methodological quality of the trials was critically assessed. Statistical software RevMan 5.0 was used for data analysis. Results: Eight articles were included in the meta-analysis. Through comparing the efficacy and safety of ilioinguinal approach and Stoppa approach in the treatment of displaced acetabular fracture, statistical significance was found in the average operation time [WMD = 68.29, 95% CI (10.52, 126.05), p < 0.05] and the median intraoperative blood loss [WMD = 142.26, 95% CI (9.30, 275.23), p < 0.05]. However, there existed no statistical significance in the fracture end reset satisfaction rate [RR = 0.63, 95% CI (0.17, 2.37), p > 0.05], the early complications rate [RR = 0.89, 95% CI (0.33, 2.40), p > 0.05], the late complications rate [RR = 0.91, 95% CI (0.27, 3.01), p > 0.05], and Harris hip score good function rate [RR = 0.52, 95% CI (0.25, 1.10), p > 0.05]. Conclusion: Though both techniques can obtain satisfactory clinical functions in the treatment of displaced acetabular fractures, Stoppa approach is superior to the ilioinguinal approach in terms of operation time and intraoperative blood loss.     

涉及髋臼四边体骨折的治疗体会

目的探讨采用髂腹股沟入路、Kocher-Langenbeck入路或联合入路切开复位骨盆重建钢板结合拉力螺钉内固定治疗涉及髋臼四边体骨折的临床疗效。方法自2006年5月至2011年4月我科治疗的24例涉及髋臼四边体骨折患者,其中男17例,女7例;年龄18～59岁,平均38.5岁。骨折按Letournel分类,后柱骨折2例,后柱伴后壁骨折2例,横形骨折3例,"T"形骨折3例,前柱伴后半横形骨折2例,双柱骨折12例。结果 24例均获得随访,时间6～36个月,平均21个月。临床疗效按照改良后的Modified d′Aubigne and Postel髋关节评分标准,优13例,良6例,可3例,差2例,优良率79.16%。结论髂腹股沟入路、Kocher-Langenbeck入路或联合入路骨盆重建钢板结合拉力螺钉内固定治疗髋臼四边体骨折,具有显露清楚、便于骨折复位、固定稳定、临床效果满意等优点,是治疗涉及髋臼四边体骨折合并股骨头中心脱位的有效方法。     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.     

Stoppa入路在骨盆髋臼骨折中的初步应用

目的 探讨在骨盆髋臼骨折中采用耻骨联合上缘横形或下腹正中切口,真骨盆内操作(Stoppa人路)的初步临床经验. 方法对2008年3月至11月问应用Stoppa入路治疗的10例骨盆髋臼骨折患者进行总结.5例骨盆患者均为Tile C型,Stoppa入路复位同定前环的高位耻骨支骨折.髋臼骨折为横行2例,双柱、T型及后柱(四边体粉碎骨折伴中心脱位)骨折各1例,单纯Stoppa入路2例,联合Kocher-Langenbeck及髂腹股沟入路3例. 结果所有骨盆骨折均复位优,所有髋臼骨折均解剖复位.Stoppa入路平均切口长度10 cm(9～12 cm),平均手术时间88 min(75～105 min),半均出血560 mL(250～800 mL),无手术并发症.7例获得4～8个月随访,功能结果均满意. 结论 Stoppa入路可以替代髂腹股沟入路治疗高位耻骨支骨折,也可单独或联合其他入路治疗髋臼骨折,具有操作简单、并发症少的优点.