经K-L入路治疗髋臼骨折疗效观察

目的探讨经K-L入路内固定治疗髋白骨折的临床疗效。方法对35例髋臼骨折患者采用K-L入路内固定治疗。随访观察固定效果。结果患者均获随访,时间1~12(4.2±1.1)年。骨折均获愈合,时间12.5~14.6(14.2±0.5)周。末次随访依据Merle d'Aubigne-Postel髋关节评分标准评价临床疗效:优15例,良11例,可4例,差5例,优良率达74.3%。参照Matta标准评价骨折复位:解剖复位22例,满意复位10例,不满意复位3例。术后1例伤口感染,1例坐骨神经损伤,1例泌尿系统结石,1例异位骨化,4例股骨头缺血性坏死,3例创伤性关节炎。其中合并股骨头(颈)骨折患者易发生术后股骨头缺血性坏死,与术前无股骨头(颈)骨折患者比较差异有统计学意义(P0.05)。结论经K-L入路内固定手术治疗部分髋臼骨折可取得较良好结果,保护股骨头血供可预防术后并发症进而提高手术疗效。

The clinical observation of K-L approach in the treatment for acetabular fractures

Objective To investigate the clinical effect of acetabular fractures treated with reconstruction plate through the K-L approach. Methods 35 patients with acetabular fractures were treated with reconstruction plate via the K-L approach. All the patients were followed up and the fixation effect was observed. Results All cases were followed up for 1 -12 （ 4. 2 ± 1. 1 ） years. Bone union was achieved in all cases, and the time was 12. 5 -14. 6 （14. 2 ± 0. 5） weeks. According to Merle d′Aubigne-Postel criteria at the final follow-up, 15 cases were excellent, 11 good, 4 fair and 5 poor, the clinical excellent and good rate was 74. 3%. Based on the Matta standards, the frac-ture reduction results were as follows：22 cases were anatomic reduction, 10 satisfactory reduction, 3 unsatisfactory reduction. Postoperative complications were wound infection （1 case）, sciatic nerve injury （1 case）, urinary tract stones （1 case）, avascular necrosis （4 cases）, and traumatic arthritis （3 cases）. Combination with femoral head （ neck） fractures had an tendency to postoperative ischemic necrosis and delayed hip dislocation increased the postop-erative complications rate（P〈0. 05）. Conclusions Part of the acetabular fractures can be treated with internal fixa-tion via K-L approach and achieve relatively good results. Protection of the blood supply of the femoral head may re-duce the postoperative complications and improve the clinical effects.