经单一腹直肌旁入路切开复位内固定治疗髋臼双柱骨折

目的探讨经单一腹直肌旁入路切开复位内固定治疗髋臼双柱骨折患者的临床疗效。方法采用回顾性病例系列研究分析2015年6月至2019年6月山东第一医科大学附属省立医院收治的44例髋臼双柱骨折患者临床资料,其中男29例,女15例;年龄21-72岁(41.3±8.4)岁]。均采用单一腹直肌旁入路切开复位内固定治疗,记录手术时间、术中出血量及骨折愈合时间。末次随访时根据Matta影像学评估标准评估骨折复位情况,根据改良Merle D'Aubigne和Postel评价标准评估髏关节功能.观察并发症情况.结果40例患者获随访,4例患者失访,随访时间为12?46个月(30.5±6.4)个月]。手术时间为45~150 min(111.2±20.6)min],术中出血量为200-1200 ml(398.5±78.5)ml]。患者均获骨性愈合,愈合时间为10~16周(11.8±3.3)周]。末次随访Matta影像学评估标准评价:优29例,良7例,中3例,差1例,解剖复位率为90%。末次随访改良Merle D'Aubigne和Postel评价标准评定:优27例,良6例,中6例,差1例,优良率为83%01例发生异位骨化,未对髋关节功能造成影响,未予特殊处理;1例异物反应,给予抗感染治疗最终得到控制,于术后1年再次手术取出内固定物3例轻度骨关节炎,给予口服消炎镇痛药物后缓解。2例下肢深静脉血栓形成,经低分子肝素等抗凝治疗痊愈。结论单一腹直肌旁入路切开复位内固定治疗傩臼双柱骨折可以兼顾前柱、四边体及后柱,同时髋臼复位及功能恢复满意、术后并发症少,是一种可供选择的手术方案。

Treatment of double-column acetabular fractures with open reduction and internal fixation through a single lateral rectus abdominis approach

Objective To investigate the clinical effect of open reduction and internal fixation for the treatment of double-column acetabular fractures by lateral rectus abdominis approach.Methods A retrospective case series study was conducted to analyze the data of 44 patients with double-column acetabular fractures admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2015 to June 2019.Tliere were 29 males and 15 females,with the age of 21-72 years(41.3±8.4)years].All patients were treated by open reduction and internal fixation through a single lateral rectus abdominis approach.Operation time,intraoperative blood loss and fracture healing time were recorded.The quality of fracture reduction was assessed according to the Matta reduction criteria,and hip function by the modified Merle D'Aubigne and Postrl score at last follow-up.Postoperative complications were observed.Results A total of 40 patients were followed up and 4 patients were lost to follow-up.The follow-up time was 1246 months(30.5±6.4)months].The operation time ranged from 45 to 150 minutes(111.2±20.6)minutes],and the intraoperative blood loss was 200-1200 ml(398.5±78.5)ml].The fractures were healed,with the healing time of 10 to 16 weeks(11.8±3.3)weeks].At last follow-up,according to the Matta criteria,the results were excellent in 29 patients,good in 7,fair in 3,poor in 1,with the excellent and good rate of 90%.At last follow-up,according to the Merle D'Aubigne and Postel score,the results were excellent in 27 patients,good in 6,fair in 6,poor in 1,with the excellent and good rate of 83%.One patient had heterotopic ossification with no impact on hip function,and no special treatment was given.One patient with the reaction of foreign body was finally controlled by anti-infection treatment,and the internal fixation was removed again one year after operation.Three patients with mild osteoarthritis were relieved by oral anti-inflammatory and analgesic chugs.Two patients with deep venous thrombosis of lower extremities were cured by anti-coagulation therapy such as low moleculai'weight heparin.Conclusions The single rectus abdominis approach for open reduction and internal fixation of double-column acetabular fractures can take into account the anterior column,quadrilateral body and posterior column.Meanwhile,this approach has advantages of satisfactory acetabular reduction and functional recovery,and less postoperative complications,suggesting an alternative procedure for treatment of double-column acetabular fractures.