微创髂腹股沟小切口联合后路K-L切口治疗髋臼双柱骨折

Operative treatment for double-column acetabular fractures through minimally invasive ilioinguinal approach combined with posterior Kocher-Langenbeck approach

目的探讨微创髂腹股沟小切口联合后路K-L切口治疗髋臼双柱骨折的手术治疗效果。方法选择2010年7月~2014年8月日照市人民医院收治的伤后3周内行切开复位内固定的46例髋臼骨折,其中按Judet-Letournel分类均为双柱骨折且采用微创髂腹股沟小切口联合后路K-L切口进行手术的患者19例,均采用漂浮体位,微创髂腹股沟切口联合后路K-L切口,髋臼前柱钢板放置在髂耻连线上（沿耻骨结节向外经过髂耻隆起到髂结节这条连线）,并非通常的骨盆界线上,内固定材料均使用重建钢板和螺钉。评估术中出血情况及术后患者功能恢复情况。结果平均随访13.5月（7~26个月）,19例患者临床愈合。术中出血量310~1 100m L,平均540m L。根据Matta标准评估骨折复位情况,解剖复位14例,良好复位4例,较差复位1例。髋关节功能按照D’Aubigne评分：优13例,良2例,可3例,差1例。异位骨化1例。无感染,无股神经、坐骨神经、股血管损伤,无下肢静脉血栓等并发症发生。结论采用微创髂腹股沟小切口联合后路K-L切口,可以对髋臼双柱骨折进行良好的显露、固定,符合微创理念。髂耻前柱放置钢板操作简单,固定坚强可靠。

Objective To explore the clinical effect of operative treatment for double-column acetabular fractures through minimally invasive ilioinguinal approach combined with posterior Kocher-Langenbeck approach.Methods From Jul. 2010 to Aug. 2014,46 acetabular fracture patients who were treated by open reduction and internal fixation in our department within 3 weeks after injury were selected for this study. Among them,19 patients who were diagnosed as both-columns fractures according to Judet-Letournel＇s classification system,were treated through minimally invasive ilioinguinal approach combined with posterior Kocher-Langenbeck approach. All the 19 cases were put in a floating position. The reconstruction plates were placed on the iliopubic line（ from pubic tubercle to tubercle of iliac crest through iliopubic eminence）. Intra-operative blood loss was measured and postoperative functional outcomes were evaluated at follow-ups. Results All cases obtained an average follow-up of 13. 5 months（ range,7 to 26 months）. Intra-operative blood loss was 540 m L on average（ range,310 to 1100 m L）. The quality of reduction according to Matta＇s criteria was graded as excellent in 14 cases,good in 4 cases,and poor in 1 case. Hip functions were excellent in 13 patients,good in 2,fair in 3,and poor in 1 patient according to the D＇Aubigne scoring system. Heterotopic ossification was observed in 1 patient. No complication such as infection,iatrogenic nerve injury or deep venous thrombosis occurred. Conclusion The modified ilioinguinal approach combined with posterior Kocher-Langenbeck approach for treating double column acetabular fractures can obtain good exposure and reliable fixation. The iliopubic anterior column plate has advantages of simple operation and reliable fixation.