高位髂腹股沟入路治疗累及四方区髋臼骨折

 目的 探讨高位髂腹股沟入路治疗累及四方区髋臼骨折术后疗效、影像学结果及围手术期并发症。方法 回顾性分析 2010 年 10 月至 2012 年 11 月，采用高位髂腹股沟入路治疗 22 例累及四方区的髋臼骨折患者资料，男 12 例，女10例；年龄 16~62岁，平均 35.2岁。根据 Letournel-Judet分型：双柱骨折 6例，前柱骨折 12例，前柱伴后半横行骨折 2例，横行骨折 1例，“T”形骨折 1例。术后骨折复位情况根据 Judet位骨盆 X线片，按照 Matta标准进行评价，髋关节功能按照改良 Merle D'Aubigné评分进行评价。结果 22例患者均获得随访，随访时间 9~28个月，平均 13.5个月。根据骨折复位的 Matta标准：解剖复位 15例（68.18%，15/22），满意复位 5例（22.73%，5/22），不满意复位 2例（9.09%，2/22），满意率为 90.91%。末次随访时，Merle D’Aubigné评分为 10~18分，平均 16.7分，其中优 16例，良 4例，差 2例，优良率为 90.91%（20/22）。无一例形成腹股沟疝或腹壁疝，其中 2例患者出现股外侧皮神经损伤症状，1例出现血管损伤，1例出现伤口脂肪液化。结论 高位髂腹股沟入路是一种治疗复杂骨盆髋臼骨折，特别是累及四方区髋臼骨折的一种新入路，可克服经典髂腹股沟入路和改良 Stoppa 入路的缺点，直视四方区和死亡冠，更好地复位和固定骨折。

The superior-ilioinguinal approach: a new approach beyond the classical ilioinguinal or modified Stoppa approach

Objective To explore treatment effects, image results and preoperative complications of the acetabular fractures managed by the superior ilioinguinal approach. Methods Clinical and follow-up data of 22 patients with acetabular fracture involving the quadrilateral plate managed operatively by superior ilioinguinal approach from October 2010 to November 2012were retrospectively analyzed. Among them 12 cases were male and 10 cases were female, with an average age of 35.2 years old (range, 16-62 years old). According to the fracture classification of Letournel and Judet, there were 6 cases associated with two column fractures, 12 anterior column fractures, 2 anterior column fractures with posterior hemitransverse, 1 transverse and 1 T-shaped. We classificated image results by Matta standard and assessed the results of acetabular function after surgery by modified Merle D'Aubigné score. Results The 22 patients were with followed up for at least 9 months. Average time of the 22 patients from injury to operation was 5 days. Average blood loss was 750 ml, and average operative time was 186 min. According to the criteria described by Matta, 68% of the reductions were graded excellent, 23% were graded good, and 9% poor. Clinical outcomes (Merle D'Aubigné) at 9 months were 73% excellent, 18% good, and 9% poor. No inguinal or abdominal wall hernias occurred. The lateral femoral cutaneous nerve was injured in two patients, due to the trauma or traction during surgery. One patient (4.5%) had a vascular injury. One patient had a fatty fluidization. All patients had 9 to 28 months follow-up (mean, 13.5 months). In the last follow-up anatomic reduction were achieved in 15 cases, a satisfactory reduction in 5 and poor reduction in 2. Hip functional results were excellent in 16 cases, good in 4, poor in 2, on the basis of Matta standard and Modified Merle D'Aubigné score. The lateral femoral cutaneous nerve injuries were found in 2 cases, vascular injury and fatty fluidization in 1 case respectively. Conclusion The superior ilioinguinal approach, including the pararectus approach belongs to a new way and has advantages over classic ilioinguinal approach and modified Stoppa approach, which could overcome disadvantages of lack“direct vision”to quadrilateral surface and Corona Mortis artery.