腹直肌旁入路髋臼下通道螺钉固定复杂髋臼骨折
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滨州医学院附属医院

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山东省自然科学基金青年项目(编号:ZR2020QH071);滨州医学院科研计划与科研启动基金(编号:BY2017KJ31)


Fixation of complex acetabular fractures with infra-acetabular screw through the pararectus approach
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Binzhou Medical University Hospital

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    摘要:

    [目的] 介绍腹直肌旁入路髋臼下通道螺钉固定复杂髋臼骨折的手术与治疗技术和初步临床结果。[方法] 回顾性分析2019年7月至2022年6月经腹直肌旁入路应用髋臼下通道螺钉治疗14例复杂髋臼骨折患者资料,手术在单一经腹直肌旁入路下复位固定,沿骨盆界限上缘放置重建钢板固定前柱骨折;通过髂坐钢板或梳状螺钉固定四边体;通过腹直肌旁入路第三窗在髂耻隆起偏尾端偏内侧指向坐骨结节置入1枚髋臼下通道螺钉。评价围手术期、随访及影像结果。[结果] 14例患者均获得随访,手术时间平均(153.545.6)min,术中出血平均(465.7249.5)ml,2例患者发现下肢肌间静脉血栓,给予抗凝治疗3个月;无一例发生血管神经损伤及感染情况。采用Matta方法评价骨折复位质量,其中优12例,良2例;髋臼下螺钉位置其中12例在通道内,2例螺钉穿透皮质;末次随访时,Merled'Aubigne-Postel评分为14~18分,其中优9例,良4例,可1例。[结论] 采用单一经腹直肌旁入路复位固定复杂髋臼骨折,其中使用髋臼下通道螺钉固定前后柱以增强整体内固定稳定性,能够取得满意的临床效果。

    Abstract:

    [Objective] To introduce the surgical and therapeutic techniques and preliminary clinical results of infra-acetabular screw fixation of complex acetabular fractures through the pararectus approach. [Method] A retrospective was conducted on the data of 14 patients with complex acetabular fractures treated with infra-acetabular screw through the pararectus approach from July 2019 to June 2022. The surgery included reduction and fixation through a single pararectus approach, and reconstruction plates were placed along the upper edge of the pelvic boundary to fix the anterior column fractures; Fix the quadrilateral body with iliosciatic plate or comb screw; Insert a infra-acetabular screw through the third window of the pararectus approach,pointing from the caudal and medial end of the iliac pubic eminence to the ischial tuberosity,Evaluate the perioperative period, follow-up, and imaging results.[Results] All 14 patients were followed up. The operation time was (153.545.6) min, and the blood loss was (465.7249.5) ml. Two patients found lower limb intermuscular vein thrombosis and were given anticoagulant treatment for 3 months; No cases of vascular or nerve injury or infection occurred. The Matta method was used to evaluate the quality of fracture reduction, Including excellent in 12 cases and good in 2 cases; The position of the screws was found in 12 cases within the channel, and 2 cases penetrated the cortex; At the last follow-up, the Merled'Ambigne-Postel score was 14-18, with excellent in 9 cases, good in 4 cases and fair in 1 case.[Conclusion] A single pararectus approach was used to reduce and fix complex acetabular fractures, in which the anterior and posterior columns were fixed with infra-acetabular screw to enhance the overall stability of internal fixation, can achieve satisfactory clinical results.

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  • 收稿日期:2023-04-20
  • 最后修改日期:2023-06-15
  • 录用日期:2023-11-01
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