单一腹直肌外侧切口开放复位内固定双柱髋臼骨折

Open reduction and internal fixation of double-column acetabular fractures through a single lateral rectus approach

摘要:

［目的］ 介绍单一腹直肌外侧切口治疗双柱髋臼骨折的手术技术和初步临床效果。［方法］ 2016 年 9 月—2019 年 7 月，采用腹直肌外侧切口治疗双柱髋臼骨折 32 例，其中男 14 例，女 18 例；年龄 21~72 岁，平均（36.42±4.73）岁。腹直肌外侧切口显露髋臼，以髂外动静脉为分割显露第一、二窗，以髂腰肌外侧为第三窗。术中一窗配合二窗显露前柱、四方体及后柱并复位固定；应用第三窗显露髂缘并复位固定；采用 Matta 评价髋臼功能评级及改良 Merle D' Aubigne 和 Postle 评价术后髋关节功能。［结果］ 所有患者均顺利完成手术，无明显并发症。随访 9~24 个月，平均 （14.73±2.34） 个月；应用 Matta 评价骨折复位情况：优 21 例，良 7 例，可 4 例，优良率 87.50%。末次随访应用 Merle D' Aubigne 和 Postle 进行髋关节功能评价：优 19 例，良 8 例，可 4 例，差 1 例，优良率 84.38%。［结论］腹直肌外侧入路治疗双柱髋臼骨折，具有切口小，四方体及前柱显露充分，直视下后柱螺钉及髂坐钢板的固定，并发症少等优点，值得推广。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of open reduction and internal fixation (OR- IF) of double- column acetabular fractures through a single lateral rectus abdominis approach. [Methods] From September 2016 to July 2019, 32 patients with double-column acetabular fractures were treated by ORIF through a single lateral rectus abdominis approach, in- cluding 14 males and 18 females, aged ranged from 21 to 72 years, with an average of (36.42±4.73) years. The acetabulum was exposed through the lateral incision of the rectus abdominis. The first and second windows were separated by the external iliac artery and vein, while the third window was the lateral iliopsoas muscle. The anterior column, quadrilateral area and posterior column were exposed, reduced and fixed by the combination of the first window and second window, while the iliac margin was exposed, reduced and fixed by the third window. The acetabular reduction was evaluated by Matta's criteria, whereas postoperative hip function was evaluated by modified Merle D 'Aubig- ne and Postle criteria. [Results] All patients had operation completed smoothly without obvious complications, and followed up from 9 to 24 months with a mean of (14.73±2.34) months. Based on Matta's criteria, quality of fracture reduction was of excellent in 21 cases, good in 7 cases, fair in 4 cases, with excellent rate of 87.5%. By the time of the latest follow-up, the clinical outcome was marked as excellent in 19 cases, good in 8 cases, fair in 4 cases and poor in 1 case with an excellent and good rate of 84.3% according to Merle D 'Aubigne and Pos- tle's criteria. [Conclusion] The lateral rectus abdominis approach has the advantages of small incision, full exposure of quadrilateral area and anterior column, as well as fixation of posterior column with screw and iliac plate under direct vision, and fewer complications.