微创髂腹股沟小切口联合后路K-L切口治疗髋臼双柱骨折

摘要

Objective To explore the clinical effect of operative treatment for double-column acetabular fractures through minimally invasive ilioinguinal approach combined with posterior Kocher -Langenbeck approach . Methods From Jul.2010 to Aug.2014,46 acetabular fracture patients who were treated by open reduction and in-ternal fixation in our department within 3 weeks after injury were selected for this study .Among them,19 patients who were diagnosed as both-columns fractures according to Judet-Letournel ’ s classification system , were treated through minimally invasive ilioinguinal approach combined with posterior Kocher -Langenbeck approach .All the 19 cases were put in a floating position .The reconstruction plates were placed on the iliopubic line ( from pubic tuber-cle to tubercle of iliac crest through iliopubic eminence ) .Intra-operative blood loss was measured and postoperative functional outcomes were evaluated at follow-ups.Results All cases obtained an average follow-up of 13.5 months (range,7 to 26 months).Intra-operative blood loss was 540mL on average (range,310 to 1100mL).The quality of reduction according to Matta’s criteria was graded as excellent in 14 cases,good in 4 cases,and poor in 1 case.Hip functions were excellent in 13 patients,good in 2,fair in 3,and poor in 1 patient according to the D ’Aubigne scoring system.Heterotopic ossification was observed in 1 patient.No complication such as infection ,iatrogenic nerve inju-ry or deep venous thrombosis occurred .Conclusion The modified ilioinguinal approach combined with posterior Kocher-Langenbeck approach for treating double column acetabular fractures can obtain good exposure and reliable fixation.The iliopubic anterior column plate has advantages of simple operation and reliable fixation .%目的：探讨微创髂腹股沟小切口联合后路K-L切口治疗髋臼双柱骨折的手术治疗效果。方法选择2010年7月～2014年8月日照市人民医院收治的伤后3周内行切开复位内固定的46例髋臼骨折，其中按Judet-Letournel分类均为双柱骨折且采用微创髂腹股沟小切口联合后路K-L切口进行手术的患者19例，均采用漂浮体位，微创髂腹股沟切口联合后路K-L切口，髋臼前柱钢板放置在髂耻连线上（沿耻骨结节向外经过髂耻隆起到髂结节这条连线），并非通常的骨盆界线上，内固定材料均使用重建钢板和螺钉。评估术中出血情况及术后患者功能恢复情况。结果平均随访13.5月（7～26个月），19例患者临床愈合。术中出血量310～1100mL，平均540mL。根据Matta标准评估骨折复位情况，解剖复位14例，良好复位4例，较差复位1例。髋关节功能按照D’ Aubigne评分：优13例，良2例，可3例，差1例。异位骨化1例。无感染，无股神经、坐骨神经、股血管损伤，无下肢静脉血栓等并发症发生。结论采用微创髂腹股沟小切口联合后路K-L切口，可以对髋臼双柱骨折进行良好的显露、固定，符合微创理念。髂耻前柱放置钢板操作简单，固定坚强可靠。