前后联合入路重建钛板内固定治疗复杂髋臼骨折

Internal Fixation Through Combined Anterior-Posterior Approaches and Reconstruction Titanium Plate for Complex Acetabular Fractures

目的总结前后联合入路重建钛板内固定治疗复杂髋臼骨折的经验。方法对2005年2月～2009年3月应用髂腹股沟入路联合改良Gibson入路治疗29例复杂髋臼骨折的资料进行回顾性研究。结果术后患者均获随访，时间10～44个月，平均18个月。采用Matta的X线复位标准评定：解剖复位20例，满意复位5例，不满意复位4例，解剖复位率达69％；改良Merled’Aubigne and Postel髋关节评分标准评价术后功能：优6例，良19例，可3例，差1例，关节功能优良率86％；异位骨化3例，创伤性关节炎2例，股骨头坏死1例，无深部感染，无血管神经损伤。结论髂腹股沟入路联合改良Gibson入路治疗复杂髋臼骨折具有显露充分，固定牢靠，创伤较小，手术时间短，并发症少等优点，值得临床推广。

Objective To summarize the surgical treatment of complex aeetabular fractures with combined anterior - posterior approaches. Methods The clinical data of 29 cases of complex acetabular fractures treated with the combined anterior ilio - inguinal and posterior modified Gibson approaches from February 2005 to March 2009 were studied retrospectively. Results The patients have all been followed up for 10 -44 months. The average follow - up visit was 18 months. According to Matta standard, fractures were reduced anatomically in 20 cases, perfectly in 5 cases and poorly in 4 cases. The rate of anatomical reduction was 69%. The modified Merled＇Aubigne and Postel score system showed that the excellent result was found in 6 cases, good in 19 cases, fair in 3 cases and poor in 1 case. The excellent and good rate of joint function was 86%. There were 3 cases with beterotopic ossification, 2 with traumatic arthritis, and 1 with avascular necrosis of the femoral head. No deep part infection and no vascular or nerve injury happened among the patients. Conclusion The advantages of the treatment of complex acetabular fractures with the combined anterior ilio - inguinal and pos- terior modified Gibson approaches are as follows： sufficient exposure, strong fixation, small trauma, short operation time and less complication. It is worth spreading in clinic.