经腹直肌外侧切口入路重建钢板辅助后柱顺行拉力螺钉治疗复杂髋臼骨折

目的评价经腹直肌外侧切口入路以前柱重建钢板配合后柱顺行拉力螺钉内固定治疗复杂髋臼骨折的临床疗效。方法回顾性分析自2012年5月~2014年1月本科收治的复杂型髋臼骨折9例,其中男性6例,女性3例;年龄27~74岁,平均39岁。骨折类型:横行骨折2例,前柱加后半横4例,双柱骨折3例,伴中心脱位1例。致伤原因:道路交通伤5例,坠落伤2例,压砸伤2例。所有患者均采用单一经腹直肌外侧切口入路,以前柱钢板结合后柱顺行拉力螺钉复位固定骨折,统计患者的平均手术时间和出血量,对术后骨折复位依据X线表现按Matta标准评估,临床疗效按照改良后的Merled'Aubigne和Postel髋关节评分标准。结果平均手术时间为200min(150~255min);平均失血量为730ml(300~1250ml);术后随访9~30个月,平均15.9个月。Matta评分结果达解剖复位者6例,满意2例,可1例;髋关节评分结果,优5例,良2例,可2例。所有患者3个月内均获骨性愈合,无感染、异位骨化及股骨头坏死等并发症的发生。结论采用单一经腹直肌外侧切口入路可为部分复杂髋臼骨折提供充足手术空间,尤其对方形区的显露和后柱拉力螺钉置入存在一定优势。

Surgical treatment of complex acetabular fractures through the lateral-rectus approach with the pelvic reconstructive plate and antegrade posterior-column lag screw

Objective To evaluate the clinical value of the lateral-rectus approach with the pelvic recon-structive plate and antegrade posterior -column lag screw in the treatment of complex acetabular fractures .Meth-ods Between May 2012 and Jan.2014,9 patients with complex acetabular fractures were treated with pelvic recon-structive plate and antegrade posterior-column lag screw through the lateral-rectus approach . There were 6 males and 3 females,aged 27-74 years(mean,39 years).Fractures were caused by traffic accident in 5 cases,by falling in 2 cases,and by heavy crash in 2 cases.According to Letournel classification ,there were 2 cases of transverse frac-ture,4 cases of anterior column with posterior hemi-transverse lesion fracture,and 3 cases of both-column fracture with 1 case of central dislocation of hip joint .The operation time and blood loss were statistically analyzed .The pa-tients were evaluated clinically according to Merle d'Aubigne-Postel scoring system and X ray performance based on the criteria described by Matta .Results The average time of operation was 200 minutes ( 150-255 minutes );the average blood loss was 730ml(300-1250ml);the average follow up was 15.9 months(9-30 months);the clinical results were excellent in 5 patients,good in 2 and fair in 2.The radiological results were anatomical reduction in 5 patients,satisfactory in 3 and fair in 1.All the patients were healed within 3 months and there were no complications such as infection ,avascular necrosis of the femoral head ( ANFH) ,or heterotopic ossification .Conclusion The lat-eral-rectus approach is suitable for some complex acetabular fractures ,with advantages of the adequate exposure of quadrilateral surface and insertion of the posterior column antegrade lag screw .