单一Kocher-Langenbeck入路治疗髋臼横型或伴后壁骨折△

A single Kocher-Langenbeck approach for open reduction and internal fixation of acetabular transverse fractures with or without posterior wall fractures

摘要:

[目的]探讨单一 Kocher-Langenbeck（K-L）入路治疗髋臼横型骨折或伴后壁骨折的临床疗效。[方法]本回顾性研究纳入 2018 年—2023 年本院创伤骨科采用单一 K-L 入路开放复位内固定的髋臼横型骨折和/或髋臼横型骨折伴后壁骨折 23 例患者，其中男性 15 例，女性 8 例，年龄 22~71 岁，平均 （35.6±9.6） 岁。评价患者临床和影像资料。[结果]本组患者均顺利手术，术中无死亡、大出血等严重并发症；手术时间（184.7±21.1）min； 术中出血量（413.9±87.9）mL；术中透视次数（26.6± 4.1）次。1 例患者术后出现足部麻木，足背伸肌力减弱，给予神经营养药物治疗，术后 3 个月，症状显著缓解。所有患者未出现伤口感染、症状性血栓等并发症。所有患者均获随访，随访时间 6~63 个月，平均时间（31±9.4）个月。恢复完全负重活动的时间为术后 1.2~2.6 个月，平均（1.7±0.3）个月。末次随访时，23 例患者中，19 例恢复伤前运动能力，4 例未恢复伤前运动能力。1 例出现异位骨化，对髋关节功能有部分影响。影像方面，依据 Mata 评级标准，23 例患者骨折复位质量评定为优 7 例，良 12 例， 差 4 例。至末次随访时，所有患者 X 线检查均显示骨折愈合，愈合时间 8~14 周，所有患者均无内固定物松动、断裂等并发症发生。[结论]对于髋臼横型或伴后壁骨折，使用单一 K-L 入路，可以获得较好的临床疗效。

Abstract:

[Objective] To evaluate the clinical consequence of a single Kocher-Langenbeck (K-L) approach for open reduction and internal fixation (ORIF) of acetabular transverse fracture with or without posterior wall fracture. [Methods] A retrospective study was conducted on 23 patients who received ORIF through a single K-L approach for acetabular transverse fracture with or without posterior wall fracture in the Department of Traumatic Orthopaedics of our hospital from 2018 to 2023, including 15 males and 8 females, aged 22-71 years with an average age of (35.6±9.6) years. The clinical and imaging data were evaluated. [Results] All the patients were operated on successfully with no serious complications such as death and massive hemorrhage, whereas with operative time of (184.7±21.1) min, intraoperative blood loss of (413.9±87.9) mL, and intraoperative fluoroscopy times of (26.6±4.1) times. One patient experienced foot numbness and weakened dorsal extensor strength after surgery, received neurotrophic drugs to treat the symptoms, and got the symptoms significantly relieved 3 months after surgery. None of the patients had wound infection, symptomatic thrombosis and other complications. All patients were followed up for 6-63 months, with an average of (31±9.4) months. The time to return to full weight-bearing activity ranged from 1.2 months to 2.6 months after operation, with an average of (1.7±0.3) months. At the last followup, of the 23 patients, 19 patients recovered pre-injury sports capacity, whereas 4 patients did not regained pre-injury level. One patient had ectopic ossification, which had a partial effect on hip function. As for imaging, according to the Mata criteria, the fracture reduction quality of 23 patients was rated as excellent in 7 cases, good in 12 cases, and poor in 4 cases. At the last follow-up, X-ray showed fracture healed in all patients, with healing time ranged from 8 weeks to 14 weeks. No implant loosening or fracture was found in anyone of them. [Conclusion] For transverse acetabular fracture with or without posterior wall fracture, a single K-L approach does meet the need of ORIF to obtain satisfactory clinical consequence.