单一髂腹股沟入路治疗髋臼双柱合并后壁骨折

A single ilioinguinal approach for open reduction and internal fixation of acetabular double column and posterior wall frac⁃ tures

摘要:

［目的］评估髋臼双柱合并后壁骨折单一髂腹股沟入路复位内固定，且后壁骨块未予固定的临床结果。［方法］2016 年 5 月—2021 年 1 月对髋臼双柱合并后壁骨折的 30 例患者行手术治疗，男 17 例，女 13 例；平均年龄（41.4±15.5）岁。前柱采用钢板固定，后柱采用后柱拉力螺钉固定，后壁不予固定。评价临床与影像结果。［结果］本组 30 例患者均顺利手术，术中无严重并发症。所有患者均获得临床骨折愈合，末次随访时所有患者 VAS 评分，髋伸屈 ROM，髋内外旋 ROM，Harris 评分， Merle-d' Aubigne-Postel 评分均较术后 3 个月时显著改善（P<0.05）。影像方面，术后影像显示所有患者均达到或保持髋关节同心圆复位状态，骨折复位满意，前后柱螺钉位置良好，无突入关节腔等情况。与术后 3 个月相比，末次随访时 Matta 骨折复位评级及 Tonnis 髋退变评级均无显著变化（P>0.05）。［结论］单一髂腹股沟入路复位内固定，且后壁骨块未予处理治疗髋臼双柱合并后壁骨折取得良好的临床效果。

Abstract:

[Objective] To evaluate the clinical outcome of a single ilioinguinal approach for open reduction and internal fixation (OR- IF) for acetabular double column and posterior wall fractures with the posterior wall fracture untreated. [Methods] From May 2016 to Janu- ary 2021, 30 patients, including 17 males and 13 females aged 22-76 years, received ORIF through a single ilioinguinal approach, involv- ing plate fixation of the anterior column and lag screw fixation of the posterior column, whereas the posterior wall fracture untreated for the acetabular double column and posterior wall fractures. The clinical and imaging results were evaluated. [Results] All the 30 patients were successfully operated on without serious complications, whereas achieved clinical fracture union with significant improvement in terms of the VAS score, hip extension ROM, hip internal and external rotation ROM, Harris score, and Merle-d 'Aubigne-Postel score at the latest follow-up compared with those at 3 months postoperatively (P＜0.05) . Radiographically, all the patients got or maintained concentric hip alignment, satisfactory reduction of fracture, proper position of anterior and posterior column implants, with no protrusion of acetabulum. The Matta grade for fracture reduction and Tonnis scale for hip degeneration remained unchanged at the latest follow-up compared with those 3 months postoperatively (P＞0.05) . [Conclusion] This single ilioinguinal approach for reduction and internal fixation with posterior wall fracture untreated achieves good clinical results for acetabular double column and posterior wall fractures