经皮空心钉结合重建钢板治疗复杂髋臼骨折

目的 通过与传统双侧入路髂腹股沟联合Kocher-Langerbeck(K-L)入路]对比研究,探讨单纯后路经皮空心钉固定前柱联合重建钢板固定后柱治疗复杂髋臼骨折的疗效. 方法 2004年4月至2007年5月,采用手术方法 治疗复杂髋臼骨折48例,横形合并后壁骨折22例,双柱骨折16例,前柱合并后壁骨折3例,"T"形骨折3例,前柱合并后半横形骨折4例.采用双入路(髂腹股沟入路和K-L入路)治疗22例,K-L入路经皮下空心钉从坐骨结节斜向上打入固定前柱骨折、重建钢板固定后壁后柱骨折26例.结果 40例患者获6个月～3年1个月(平均1年6个月)随访,双入路手术组19例,经皮空心钉组21例.双入路手术组和经皮空心钉组的手术时间分别为(175.56±50.32)、(92.82±20.56)min,手术出血量分别为(1830.22±655.40)、(988.55±321.64)mL;按Matta复位标准解剖复位分别为10、11例,满意复位8、10例,不满意复位1、0例;髋关节功能评价,优分别为8、12例,良6、7例,一般5、2例;术后并发症分别为8、3例.两组在满意复位率和髋关节功能优良率方面差异无统计学意义.但在手术时间与术中出血量方面,差异有统计学意义(P<0.05). 结论 单纯后路经皮从坐骨结节斜向上打入空心钉固定前柱联合重建钢板固定后柱治疗复杂髋臼骨折,使双侧入路简化为单侧K-L人路,从而减化了手术步骤,减少了术中出血及术后并发症.

Operative treatment of compound acetabular fractures through single posterior approach with percutaneous eannulated screws and reconstruction plates

Objective To discuss the efficacy of a modified single posterior fixation of complicated acetabular fractures with a percutaneous cannulated screw and a reconstruction plate in comparison with traditional bilateral approaches (ilioinguinal and Kocher-Langerbeek). Methods From April 2004 to May 2007, 48 cases of complicated acetabular fracture were treated surgically. By Letoumel classification, 22 were transverse and posterior wall fractures, 16 fractures of both columns, 3 fractures of anterior column and posterior wall, 3 T shape fractures and 4 anterior column and posterior hemi-transverse fractures. Of them, 22 cases were treated through the bilateral approaches and 26 cases through the modified single posterior approach by which a percutuneous cannulated screw was applied, going askew through skin and ischial tuberosity, to fix the anterior column and a reconstruction plate to fix the posterior column. Results Forty patients were followed up for 6 to 37 months(average, 18 months) . There was no statistical difference between the 2 groups as fax as the following factors were concerned: anatomic reduction rate and functional good-to-excellent rate. But there were significant differences in operation time and volume of hemorrhage during operation. Conclusion In treatment of complicated acetabular fractures, the modified singl eposterior approach simplifies traditional bilateral approaches so that surgery procedures, perioperative bleeding and postoperative complications can be reduced without sacrificing the treatment efficacy.