前后路联合切口治疗严重移位的髋臼骨折

目的总结应用前后路联合切口治疗累及双柱髋臼骨折的治疗经验。方法应用前后路联合切口治疗累及双柱的髋臼骨折25例。根据Letournel分型：横形骨折3例，横形加后壁骨折8例，双柱骨折9例，T形骨折5例。手术首先在移位明显的一侧进行。15例先选择前入路，后采用后路；10例先选择后入路，后采用前路。结果平均随诊23．2个月。根据改良的Merled Aubigne和Postel评分标准评价临床结果，其中优4例，良14例，一般3例，差4例，优良率为72％。2例出现深部感染，2例发生股骨头坏死，严重异位骨化的发生率为12％。结论对累及双柱的髋臼骨折，当一侧入路不能完成复位及内固定时，选择前后路联合入路可提高手术效果。

Surgical Treatment of Two - column Acetabular Fractures Through Anterior and Posterior Approaches

Objective To summarize the surgical treatment of two-column acetabular fractures with the combined anterior ilioinguinal and posterior Kocher-Langenbenk approaches.Methods Twenty-five patients with two-column acetabular fractures were treated in our department with the combined anterior and posterior approaches.According to classification of Letournel,there were 3 transverse fractures,5 transverse-posterior wall fractures,9 both column fractures and 5 T-shaped fractures.The anterior approach was used in 15 patients in the first step of operation,followed by the posterior approach.The posterior approach was used in 10 patients first,followed by the anterior one.The column with more significantly displaced fracture was reduced first,followed by the opposite one.Results The average follow-up period was 13.2 months.The clinical results were evaluated with the modified Merled Aubigne and Postel scoring system.The excellent result was obtained in 4 patients,good in 14,fair in 3 and poor in 4.The excellent and good results were 74%.There were 2 patients with infection(8%),and 3 with the moderate or severe heterotopic ossification.Conclusion The combined anterior and posterior approaches should be used if the anatomical reduction and rigid internal fixation can not be archived through a single exposure.