涉及髋臼方形区骨折髂腹股沟入路显露与开放复位策略分析

Strategic analysis on exposure and reduction of the acetabular quadrilateral area fracture via ilioinguinal approach

[目的]探讨涉及髋臼方形区骨折的髂腹股沟入路显露方法及复位策略。[方法]2005年1月~2012年5月采用髂腹股沟入路加动力化髋臼方形区钛板螺钉内固定系统（DAPSQ）治疗髋臼方形区骨折患者79例（79髋）,其中横形骨折6例,前柱合并后半横形骨折19例,＂T＂形骨折23例,双柱骨折31例。经中间窗显露方形区骨折,利用内、中、外三窗由近及远恢复骨盆前环连续性,再利用器械辅助复位方形区骨折,采用Matta放射学标准评价复位质量。[结果]经髂腹股沟入路中间窗能充分显露方形区骨折,可方便使用各种器械辅助复位,当同时矫正分离与旋转移位时方形区骨折即可复位。术后检查显示：解剖复位42例,良好复位28例,不满意复位9例,复位满意率88.6%。术后2例切口浅表感染,6例股外侧皮神经损伤,1例发生腹股沟疝。[结论]髂腹股沟入路能满意显露髋臼方形区骨折并利于复位,先恢复骨盆环连续性、再复位方形区骨折是有效的开放复位策略,同时抗分离与抗旋转是方形区骨折复位的关键。

[ Objective] To discuss the methods on exposure and reduction of the acetabular quadrilateral surface fracture through the ilioinguinal approach. [ Method ] Seventy -nine patients （79 hips）with acetabular quadrilateral surface fracture were treated by dynamic acetabular plate - screws for quadrilateral area（DAPSQ） through the ilioinguinal approach at our department from January 2005 to May 2012. There were 6 cases of transverse facture, 19 cases of associated anterior and posterior hemitrans- verse fracture,23 cases of T - shaped fracture, and 31 cases of both column fracture. After the continuity of anterior pelvic ring had been restored proximally and distally through the medial, medium and lateral visible windows, the quadrilateral surface frac- ture was exposed in the medium window and reduced with the assistance of special instrucments through the ilioinguinal ap- proach. The quality of reduction was evaluated radiologically by the Matta criteria. [ Result] Quadrilateral surface fracture of ace- tabulum can be easily and completely exposed in the medium window through the ilioinguinal approach ,which facilitates the us- age of instruments and the reduction of fracture when both the separating and rotating displacements simultaneously were correc- ted. Postoperative radiological examination revealed anatomical reduction of 42 cases, functional reduction of 28 cases and unsat- isfactory reduction of 9 cases. The total satisfaction rate was 88.6%. There were some complication of operation including 2 ca- ses of superfical incision infection ,6 cases of lateral femoral cutaneous nerve injury and 1 case of inguinal hernia. [ Conclusion] Ilioinguinal approach facilitates to expose and reduce the fractures of acetabular quadrilateral area. The surgical strategy for open reduction of quadrilateral surface fracture is to restore the continuity of pelvic ring at first, and then to reduce the fracture with simultaneous restoration of both separating and rotating displacements.