复杂髋臼骨折经腹直肌旁入路复位固定

Pararectus approach for open reduction and internal fixation of complex acetabular fractures

摘要:

[目的] 探讨采用腹直肌旁入路置入内髂坐钢板治疗累及后柱的复杂髋臼骨折的临床效果。[方法] 回顾性分析 2017 年 1 月—2018 年 12 月采用腹直肌旁入路置入内髂坐钢板治疗累及后柱的髋臼骨折 16 例患者的临床资料，评价临床与影像结果。[结果] 16 位患者均顺利完成手术，无腹腔脏器及血管、神经损伤。手术时间平均 (195.3±43.7) min，出血量平均 (710.4±232.8) ml。随访时间平均 (16.9±3.9) 个月，与术后 3 个月相比，末次随访时患者 Merle d'Aubigné 评分、Harris 评分、 髋内-外旋 ROM 及屈伸 ROM 均明显增加 (P＜0.05)。影像方面，与术后 3 个月相比，末次随访时 Tonnis 分级有所恶化，但差异无统计学意义(P＞0.05)。末次随访时所有患者均骨折愈合。[结论]对于累及后柱的复杂髋臼骨折，经腹直肌旁入路内髂坐钢板固定临床效果满意。

Abstract:

[Objective] To evaluate the clinical outcomes of pararectus approach for open reduction and internal fixation (ORIF) with internal iliosciatic plate for complex acetabular fractures involving the posterior column. [Methods] From January 2017 to December 2018, 16 patients received ORIF with internal iliosciatic plate for complex acetabular fractures involving the posterior column through the pararec- tus approach. The clinical and imaging results were evaluated. [Results] All the 16 patients had ORIF performed successfully without inju- ries to the abdominal organ, blood vessel or nerve, while with the operation time of (195.3±43.7) min and the blood loss of (710.4±232.8) ml. All the patients were followed up for (16.9±3.9) months on average. Compared with those at 3 months after operation, the Merle d 'Au- bigne score, Harris score, internal-external rotation range of motion (ROM) and flexion-extension ROM significantly increased at the last follow-up (P＜0.05) . Compared with that 3 months after surgery, the Tonnis grade for hip degeneration deteriorated at the latest follow-up, whereas which was not statistically significant (P＞0.05) . All the patients got fractures healed well at last follow-up. [Conclusion] This para- rectus approach for open reduction and internal fixation with internal iliosciatic plate does achieve satisfactory clinical consequences for complex acetabular fractures involving the posterior column.