经K-L入路治疗髋臼骨折

Acetabular Fractures Treated by Kocher-langenbeck Approach

目的:探讨K-L入路治疗髋臼骨折的方法及疗效。方法:2005年6月至2008年8月手术治疗18例髋臼骨折。采用重建钢板和螺钉内固定。结果:10例(55%)达到解剖复位,5例(27%)复位满意,3例(18%)复位欠佳。18例中有完整随访结果者16例,平均随访30月,13例骨折全部愈合,未发生感染,异位骨化率12.5%,坐骨神经损伤6.25%。根据Matta的髋关节功能评分标准:优8例(50%),良7例(43%),差1例(7%)。优良率80%。结论:髋臼骨折中,后壁骨折,后柱骨折,后柱伴后壁骨折,大部分横型骨折,及某些T型骨折可以通过单一K-L入路完成骨折的复位及内固定,手术中能达到解剖复位或接近解剖复位,术后功能良好。单一手术入路具有手术创伤小,出血少,早期可以髋关节功能锻炼,术后并发症发生率低。

Objective： To explore the methods and effects the surgical treatment by Kocher-langenbeck approach.Method： From June 2005 to August 2008,18 cases of acetabular fracture were treated with internal fixation by plate and screws through Kocher-langenbeck approach.Result： After operation anatomic reduction was achieved good in 10 cases（55%）,reduction in 5 cases（27%）,imcomplete reduction in 3 cases（18%）.Among 18 cases,16 cases had complete followed-up results.The average follow-up time of all cases was 30 months.There were 13 cases obtained solid bony fusion with no infections;The complications included heterotopic ossification was 12.5%（2 cases）,and delayed nerve injury was 6.25%（1 case）.According to Metta meliorated score on hip stand 8 cases（50%） were excellent,7 cases were good,and 1 case was fair.The excellent and good rate was 80%.Conclusion： Acetabular fractures can been treated by simple Kocher-langenbeck approach so as so posterior wall fracture;posterior column fracture;posterior wall-posterior column fracture;some transverse fracture;and some T-type fracture.The simple operation has the advantage of less trauma and minimized bleeding,restore hip function with low rate of complications.