前后入路切开复位内固定治疗移位髋臼双柱骨折

Surgical treatment of tw-column acetabular fractures through anterior and posterior approaches

目的探讨前后入路切开复位内固定治疗移位性髋臼双柱骨折的手术技巧以及临床效果。方法所有患者术中采用健侧可前后翻转的"漂浮"健侧卧位,对于不规则骨折,做前后路2个切口,由髂嵴开始,初步复位移位较多的大骨块,经髂腹股沟入路显露、复位和固定前柱和前壁骨折,对于高位骨折使用2块短钢板固定髂嵴内侧缘,根据髂耻嵴形状,使用1块钢板预弯固定,低位骨折沿髂耻嵴使用1块钢板固定,K-L入路显露、复位和固定后柱以及后壁骨折。结果本组手术平均时间(3.5±0.5)h,术中平均失血(1 135±230)ml,解剖复位达到67.9%,患者对治疗的总满意度为96.4%,治疗后总优良率为89.3%,总共发生坐骨神经牵拉伤2例,股外侧皮神经损伤4例,髂腹股沟神经损伤1例,未出现腹股沟斜疝以及骨化性肌炎等并发症。结论前后入路切开复位内固定治疗移位髋臼双柱骨折术中显露充分,其具有良好的复位效果,术后内固定稳固,并发症影响小恢复快等优点,是一种值得重视的手术方式。

Objective To investigate the operation techniques and clinical results of surgical treatment of two - column acetabular fractures through anterior and posterior approaches. Methods All patients with contralateral ＂floating＂ position, for the irregular fracture, performed the two incision of before and after road, more big bone blocks were initially reset and shifted, via ilioinguinal approach anterior column and anterior wall fractures were revealed, reduced and fixed, Two short pieces of plate fixation of the medial margin were used according to the iliopubic crest shape, K - L steel plate bending fracture fixation was used, posterior column and posterior wall fractures were reduced and fixed. Results The average operation time was （3.5 ±0.5 ） h, average blood loss was （ 1135 ±230） ml, anatomic reduction was 67.9%, the total satisfaction was 96.4%, the excellent and good rate was 89.3%, the total complication with sciatic nerve injury was in 2 cases, lateral femoral cutaneous nerve injury was in 4 cases, ilioinguinal nerve injury was in 1 case, no inguinal hernia and myositis ossificans and indirect inguinal hernia happened. Conclusion Anterior and posterior approaches in open reduction and internal fixation of displaced both - column fractures of acetabulum with sufficient exposure have a good restoration and a stable internal fixation, and few complications, so it is an important operation mode.