Kocher-Langenbeck入路加大转子截骨治疗髋关节后脱位并髋臼后柱(壁)骨折

Treatment of posterior dislocation and acetabular posterior column(wall) fracture with greater trochanteric osteotomy via Kocher-Langenbeck approach

目的探讨应用Kocher-Langenbeck入路加大转子截骨手术治疗髋关节后脱位并髋臼后柱(壁)骨折的手术方法和疗效。方法收集14例采用Kocher-Langenbeck入路结合大转子截骨手术治疗的髋关节后脱位并髋臼后柱(壁)骨折病例,分析其手术方法、术中情况及术后恢复情况。结果平均手术时间为105 min,术中平均出血量为600 mL。术后解剖复位5例,良好复位8例,复位不满意1例。临床效果优7例,良4例,可3例。3例出现异位骨化,4例发生创伤性关节炎。髋臼后柱(壁)、大转子截骨断端均骨性愈合,无医源性坐骨神经损伤及股骨头缺血坏死。结论应用Kocher-Langenbeck入路加大转子截骨治疗髋关节后脱位并髋臼后柱(壁)骨折,术中显露情况良好,有利于骨折、脱位的复位及固定。

Objective To introduce the operation method and curative effect of posterior dislocation and acetabular posterior column （wall） fracture with greater trochanteric osteotomy via Kocher-Langenbeck approach. Methods 14 cases of posterior dislocation and ace- tabular posterior column（wall） fracture who were treated by greater trochanterie osteotomy via Kocher-Langenbeck approach were collected, and the surgical methods, intraoperative situation and postoperative recovery were analyzed. Results The mean operating time is 105 min and the mean bleeding volum is 600 mL. After operation, there were 5 cases of anatomical reduction ; 8 cases of good reduction; 1 cases of unsatisfactory reduction. Among the patients, 7 cases were of excellent clinical effect; 4 cases were of good clinical effect, 3 cases were of medium clinical effect. Heterotopic ossification occurred in 3 cases and traumatic arthritis occurred in 4 case. Both acetabular posterior col- umn （wall） and trochanter osteotomy ends were healed, and there was no iatrogenic sciatic nerve and femoral head necrosis injury. Conclu- sion In treatment of posterior dislocation and acetabular posterior column （wall） fracture, greater trochanteric osteotomy via Kocher-Lange- nbeek approach can provide excellent exposure, and it is conducive to the reduction and fixation of fracture and dislocation.