髂腹股沟下入路在髋臼骨折治疗中的初步应用

目的 探讨采用髂腹股沟下入路治疗累及髋臼前方和内侧壁或合并髋关节前方损伤的髋臼骨折的可行性和优缺点.方法 对2008年5月至2010年1月采用切开复位内固定治疗的17例累及髋臼前方、内侧壁或合并髋关节前方损伤的髋臼骨折患者资料进行回顾性研究,男13例,4例;年龄23～55岁,平均39.5岁;左侧11例,右测6例.根据Letournel-Judet分类:前壁骨折2例,前柱骨折6例,前柱伴后方半横形骨折4例,双柱骨折3例,T型骨折2例.采用单一髂腹股沟下入路8例,髂腹股沟下+Kocher-Langenbeck(K-L)联合入路9例.结果 所有患者随访4～24个月,平均8.7个月,骨折愈合时间平均为14周,无切口感染,内固定松动、断裂,医源性坐骨神经或股神经损伤发生.3例患者发生Brooker Ⅰ级髋关节周围异位骨化,5例出现无症状的髂前上棘截骨处骨赘形成.根据Matta髋臼骨折复位标准:解剖复位12例,满意复位5例.按照髋关节功能的d'Aubigne和Postel标准:优13例,良3例,可1例.结论 髂腹股沟下入路可提供扩大的髋臼前壁、内侧壁及髋关节前方结构的手术显露,有利于累及髋臼前方和内侧壁或合并髋关节前方结构损伤的髋臼骨折的手术操作,对于经典的髂腹股沟入路是一良好的改进和补充.

The subinguinal approach for treatment of acetabular fractures

Objective To evaluate the subinguinal approach for the treatment of acetabular fracturesthat involve the anterior and medial walls or are combined with the anterior hip joint injury. MethodsFrom May 2008 to January 2010, 17 patients with acetabular fracture were treated through the subinguinalapproach or the subinguinal approach plus the Kocher-Langenbeck combined approach for open reduction andinternal fixation. Results All the patients were followed up for an average of 8.7 (4 to 24) months. Theaverage bone healing time was 14 weeks. No infection, internal fixation loosening, iatrogenic injury to the sciaticnerve or femoral nerve, or serious heterotopic ossification around the hip joint occurred. According to Mattacriteria for acetabular fractures, 12 cases achieved anatomical reduction and 5 satisfactory reduction. Accordingto d'Aubigne and Postel criteria, hip functions were excellent in 13 cases, good in 3 cases and fair in one.Conclusion Since the subinguinal approach allows ample exposure of the anterior and medial walls as well as ofthe anterior hip capsule, it is a good improvement and supplement to the classic ilioinguinal approach.