经腹直肌外侧入路钢板结合后柱拉力螺钉内固定治疗髋臼前后柱骨折

目的探讨经腹直肌外侧切口入路钢板结合后柱拉力螺钉内固定治疗髋臼前后柱骨折的临床疗效。方法回顾性分析自2011-03—2015-10采用经腹直肌外侧切口入路前柱钢板加后柱顺行拉力螺钉内固定治疗髋臼前后柱骨折48例的临床资料,术后根据改良的Merle D'Aubigne和Postel评价标准评价患侧髋关节功能。结果本组48例均为单一经腹直肌外侧切口入路完成手术,手术时间45~150 min,平均85 min;术中出血180~1 200 ml,平均330 ml;所有患者均获得随访10~24个月,骨折均愈合,髋臼前后柱骨折均复位良好,髋臼后柱拉力螺钉位置理想。复位标准按照Matta标准进行评估:优34例,良8例,可6例,优良率87.5%。2例出现腹壁伤口皮下脂肪液化,经换药后愈合。末次随访疗效根据改良的Merle D'Aubigne和Postel评分系统评定:优30例,良10例,可8例,优良率83.3%。结论经腹直肌外侧切口入路能从骨盆内侧面充分显露髋臼前柱、四方体及后柱,并直视下复位髋臼前后柱骨折,前柱钢板+后柱顺行拉力螺钉固定能达到稳定的固定效果。

Plate combined with posterior-column lag screw fixation via lateral-rectus approach in treatment of acetabular anterior and posterior column fractures

Objective To explore the clinical effects of plate combined with posterior-column lag screw fixation through the lateral-rectus approach in treatment of acetabular anterior and posterior column fractures.Methods Clinical data of 48 cases undergoing plate combined with posterior-column lag screw fixation through the lateral-rectus approach admitted to our hospital from March 2011 to October 2015 were retrospectively reviewed.In the follow-up of 6 months after surgery,the hip function of all patients was evaluated by modified Merle D'Aubigne and Postel scoring system.Results Forty eight cases all received single lateral-rectus approach.The average time of operation was 85 min (range,45-150 min).The average intraoperative bleeding was 330 ml (range,180-1 200 ml).All cases were followed up for 10-24 months with fracture union.Postoperative radiographic images and CT images demonstrated good reduction of acetabular anterior and posterior column,ideal position of posterior-column lag screw.Based on Matta radiological evaluation for reduction,34 cases were excellent,8good,6 fair,with an excellent and good rate of 87.5％.Subcutaneous fat liquefaction of abdominal wounds occurred in 2 cases but was healed after dressing change.Based on the modified Merle d'Aubigne and Postel scoring system,30 cases were excellent,10 good,8 fair,with an excellent and good rate of 83.3％.Conclusion Surgical management of acetabular fractures via the lateral-rectus approach with anterior-column plate and posterior-column lag screw fixation can provide adequate exposure of acetabular fractures as well as satisfactory reduction and stability fixation.