微创插板内固定治疗髋臼前柱骨折

Minimally invasive plate insertion for internal fixation of acetabular anterior column fracture

[目的]探讨采用髂腹股沟入路微创切口插板内固定治疗髋臼前柱骨折的临床疗效及优缺点。[方法]2014年5月~2016年2月,本院收治髋臼前柱骨折患者24例,采取耻骨上支和髂嵴两处小切口,行骨膜下剥离,形成髂骨嵴经髋臼前柱到耻骨支的隧道,根据髋臼前柱正常解剖结构,预折弯重建钢板放入隧道内,在耻骨上支给予2枚螺钉固定,维持髋臼前柱解剖连续性,在髂骨翼处给予3枚左右拉力螺钉,对髋臼前柱骨折端起到加压作用。[结果]随访6~39个月,平均16.9个月,骨折均愈合,术后按照Matta复位标准评定:优19例,良4例,可1例,总优良率95.8%,髋关节功能情况根据改良D,Aubigne-Postel髋关节功能评分标准评定:优18例,良5例,可1例,差1例,优良率为91.7%。[结论]髂腹股沟微创入路插板内固定治疗髋臼前柱骨折是一种可行的方法,具有创伤小、手术时间短、出血少,可显著改善髋关节功能的优点。

[Objective] To introduce surgical technique of plate fixation through minimal invasive ilioinguinal approach for the treatment of acetabular anterior column fracture. [Methods] From May 2014 to February 2016, 24 patients with ace- tabular anterior column fractures were surgically treated in our hospital. After subperiosteal dissection through two small inci- sions at the pubic rami and iliac crest, a tunnel along acetabulum anterior column ridge was created. According to the normal an- atomical structure, reconstruction plate was pre-bent and inserted into the tunnel. Afterward 2 screws were placed at the superi- or pubis ramus for maintaining anatomical continuity of the acetabulum anterior column, while 3 lag screws were inserted at the iliac wing to press the fracture ends. For high-level anterior column acetabular fractures, a large lag screw was added at the an- terior edge of iliac to enhance stability. [ Results ] All the patients were followed up for 6 to 39 months, with an average of 16.9 months. All fractures healed well after operation. According to Matta＇ s criteria, excellent anatomical reduction result achieved in 19 cases, good in 4 cases, fair in 1 case, associated with the overall excellent and good results rate of 95.8%. In term of the modified D, Aubigne and Postel hip joint function grading, excellent outcome was gotten in 18 cases, good in 5 cases, fair in 1 case, poor in 1 case, with the overall excellent and good outcomes rate of 91,7%. [Conclusion] For the acetabular anteri- or column fracture, the pre-bent reconstruction plate inserted through the minimally invasive ilioinguinal approaches for inter-alrecoveryofthe hip.