同侧髋臼合并骨盆骨折患者经腹直肌外侧直切口入路手术评估

Surgical evaluation of lateral-rectus approach for treatment of acetabular fracture combined with ipsilateral pelvic fracture

目的评价同侧髋臼合并骨盆骨折患者经腹直肌外侧直切口入路进行手术的临床疗效。方法2010年1月至2014年2月经腹直肌外侧直切口入路手术治疗同侧髋臼及骨盆骨折24例患者，18例患者单纯髋臼前部及骨盆骨折，在平卧位下实施经腹直肌外侧直切口入路的复位及固定；6例患者骨折涉及髋臼的后壁及后柱，在漂浮体位下实施腹直肌外侧直切口联合后侧K－L入路的复位及固定；内固定物均选钛合金的重建接骨板和空心螺钉。结果24例患者的手术时间为70—185min，术中的出血量为420～1100ml。髋臼骨折术后复位质量评定：13例解剖复位，8例满意复位，3例不满意复位。术后发生坐骨神经损伤的症状1例，1例患者的腹壁切口出现皮下脂肪液化。术后24例患者均获随访13～30个月，骨折的愈合时间为10一16周。术后6个月评定疗效：优16例，良6例，可2例。结论同侧髋臼合并骨盆骨折腹直肌外侧直切口入路进行手术，对于累及前柱、方形区的髋臼骨折术中可充分暴露并及时处理，也可同时对同侧耻骨上支、骶髂关节及髂骨翼周围的骨折给予有效复位及固定，临床疗效良好。

Objective To explore the clinical effect of lateral-rectus approach for treatment of acetabular fracture combined with ipsilateral pelvic fracture. Methods From January 2010 to February 2014, 24 patients with acetabular fracture combined with ipsilateral pelvic fracture were surgically managed through the lateral-rectus approach. Eighteen cases of merely anterior acetabular and pelvic fractures were treated with the lateral-rectus approach only, in the supine position. Six cases involving the posterior acetabular wall and posterior column were treated with the lateral-rectus approach combined lateral-rectus and posterior Kocher-Langenbeck approaches, in the floating position. The titanium reconstruction plates and cannulated screws were applied in these cases. Results The operation time was 70- 185 min and the intraoperative blood loss was 420-1 100 ml. Postoperative X-ray and CT exams showed excellent and good reduction. According to the postoperative Matta radiological evaluation, reduction of acetabular fracture was rated as anatomic in 13 cases, with satisfactory reduction in 8 cases and unsatisfactory in 3 cases. Injury to the sciatic nerve occurred in one case, and fat liquefaction at the abdominal incision in one case. All the patients were followed up for 13- 30 months and the fractures healed after 10- 16 weeks. According to the modified Merle d＇Aubigne and Postel scoring system, 16 eases were excellent, 6 cases were good and 2 cases were fair 6 months after operation. Conclusions Surgical management of acetabular fractures through the lateral-rectus approach can provide adequate exposure and treatment for not only the acetabular fractures involving the anterior column and the quadrilateral surface, but also ipsilateral fractures involving the pubic superior ramus, iliac ala and sacroiliac joint, leading to fine outcomes.