旁正中入路治疗涉及前柱的髋臼骨折
Treatment of acetabular fractures involving the anterior column through the paramedian approach
目的 探讨旁正中入路治疗涉及前柱的髋臼骨折的临床效果. 方法 回顾性分析2013年8月至2014年12月采用旁正中入路治疗且获得随访的56例髋臼骨折患者资料,男34例,女22例;年龄为29~58岁,平均38岁.髋臼骨折按Letournel-Judet分型:前柱骨折12例,前柱加后半横形骨折18例,横形骨折9例,T形骨折6例,双柱骨折11例.所有患者采用旁正中入路切开复位内固定治疗,皮肤切口为腹正中纵形切口,在患侧沿腹白线旁2~3 cm纵形切开腹直肌前鞘,将腹直肌牵向患侧,切开后鞘行盆腔内深部分离以显露骨折部位.12例合并髂骨翼骨折患者结合髂窝入路. 结果 本组患者手术时间为96 ~ 188 min,平均105 min;术中出血量为200 ~800 mL,平均400 mL;输红细胞0~4个单位,平均2.4个单位.56例患者术后获6~ 22个月(平均16个月)随访.术后骨折复位质量根据Matta髋臼骨折复位标准评定:优38例,良11例,可4例,差3例,优良率为87.5%.所有患者骨折均在术后3个月内愈合.末次随访时根据改良Merle d'Aubigné和Postel评分系统评定髋关节功能:优34例,良12例,可6例,差4例,优良率为82.1%.随访期间无一例患者发生腹壁疝、伤口感染及主要神经、血管损伤等并发症. 结论 旁正中入路治疗髋臼骨折可充分显露髋臼前壁、前柱和后柱,操作简便,不易损伤重要血管、神经,术中出血量少,疗效满意.该入路可解决大部分涉及前柱的髋臼骨折的手术治疗.
更多Objective To explore the surgical techniques and clinical efficacy of the paramedian approach in the treatment of acetabular fractures involving the anterior column.Methods From August 2013 to December 2014,56 patients with acetabular fracture were treated through the paramedian approach.They were 34 men and 22 women,aged from 29 to 58 years (average,38 years).According to Letournel-Judet classification,12 cases were anterior column fracture,18 cases fracture of anterior column plus posterior hemitransverse,9 cases transverse fracture,6 cases T-shape fracture,and 11 cases both column fracture.All patients were treated by open reduction and internal fixation through the paramedian approach after general anesthesia.After an abdominal midline longitudinal incision was made,the rectus abdominis anterior sheath was cut longitudinally 2-3 cm para-linea alba.After the rectus abdominis was retracted to the lesion side,the rectus abdominis posterior sheath was cut to expose the deep pelvic fracture.In the 12 patients who had been complicated with iliac wing fracture,an additional iliac fossa approach was used.Results The mean surgical time was 105 min (range,from 96 to 188 min);the mean blood lose was 400 mL (range,from 200 to 800 mL);red cell transfusion was 2.4 units (range,from 0 to 4 units).The 56 patients were followed up for an average of 16 months (range,from 6 to 22 months).According to the Matta's fracture reduction assessment,38 cases were excellent,11 good,4 fair,and 3 poor,giving a good-to-excellent rate of 87.5%.All factures healed within 3 months.According to the modified Merle d 'Aubigne & Postel scoring at the end of follow-up,the hip joint function was rated as excellent in 34 cases,good in 12,fair in 6 and poor in 4,giving a good-to-excellent rate of 82.1%.No abdominal wall hernias,wound infection or injury to major nerves or vessels was observed during follow-up.Conclusions In the treatment of acetabular fractures involving the anterior column,the paramedian approach can fully reveal anterior wall,anterior column and posterior column of the acetabulum.It is easy to handle and unlikely to injure major vessels and nerves.It also leads to less blood loss.This approach can be used for the majority of acetabular fractures involving the anterior column.
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