前后联合入路治疗陈旧性髋臼骨折的效果分析

Operative treatment of delayed acetabular fractures through combined anterior and Kocher-Langenbeck approaches

目的探讨前后联合入路治疗陈旧性髋臼骨折的临床效果。方法回顾性分析2012年2月至2017年2月重庆医科大学附属第一医院骨科收治的31例陈旧性髋臼骨折患者的临床资料，男性18例，女性13例；年龄48.5岁（范围：23～67岁）。受伤至手术时间为35.9 d（范围：22～183 d）。31例患者中，骨折按Letournel－Judet分类：横形＋后壁骨折6例，前柱＋后半横形骨折8例，双柱骨折12例，＂T＂形骨折5例。手术入路均采用前后联合入路，其中髂腹股沟入路＋Kocher－Langenbeck（K－L入路）13例，延长的髂股入路＋K－L入路4例，改良stoppa入路＋K－L入路7例，腹直肌旁入路＋K－L入路7例。复位情况与X线检查结果、临床结果间的相关性采用Spearman相关分析。结果随访截至2017年8月，31例患者均获得随访，随访率为100%，随访时间为36.0个月（范围：6～55个月）。术后4周、12周、6个月、12个月、18个月进行随访，采用门诊和电话随访等方式为主。通过计算得出复位效果与临床效果及X线片的结果成正相关（r＝0.823、0.856，P值均〈0.05）。复位质量按Matta标准分类：解剖复位11例（35.5%），满意复位13例（41.9%），较差复位7例（22.6%），优良率为77.4%。功能复位按Matta改良的髋关节功能评分分类：优8例（25.8%），良11例（35.5%），可8例（25.8%），差4例（12.9%）；优良率为61.3%。结论前后联合入路治疗陈旧性髋臼骨折能够充分显露髋臼前后方，利于陈旧性髋臼骨折的松解及固定，疗效肯定。

ObjectiveTo discuss the clinical outcomes of treating delayed acetabular fractures by combined anterior and posterior approach.MethodsA retrospective analysis was conducted of 31 delayed acetabular fractures from February 2012 to February 2017 in the First Affiliated Hospital of Chongqing Medical University, including 18 males and 13 females with age of 48.5 years（23 to 67 years） .The injury to the operation time was 35.9 days（22 to 183 days）. Of these 31 cases, there were 6 cases of transverse and posterior wall fracture, 8 cases with anterior column＋ posterior half transverse fracture, 12 cases with double column fracture and 5 cases of ＂T＂ type fracture according to Letournel-Judet classification.All fractures were treated combined anterior and Kocher-Langenbeck approaches, including 13 cases of ilioinguinal approach＋ Kocher-Langenbeck（K-L approach）, 4 cases of extensile acetabular approach, 7 cases of stoppa approach ＋ K-L approach and 7 cases of side rectus femoris approach.Correlation was analyzed by Pearson correlation regression testing.ResultsFollow up to August 2017, all patients were followed up with 36.0 months（from 6 to 55 months）. As calculated, the restorational effect was positively with result of the X-ray film and the clinical effect（r=0.823, 0.856; both P〈0.05）. The evaluation was conducted with Matta′s reduction criteria： there were 11 cases classified as anatomic reduction（35.5%）, 13 cases as satisfactory reduction（41.9%）, and 7 cases as unsatisfactory reduction（22.6%）. Excellent and good rate was 77.4%. Functional reductions were categorized by the standard of Matta hip score： 8 excellent cases（25.8%）, 11 good cases（35.5%）, 8 fail cases（25.8%）, and 4 poor cases（12.9%）.ConclusionThe treatment of delayed acetabular fracture by combined anterior and posterior approach can fully exposure the anterior and posterior acetabular fcloumns, which is beneficial to the release and fixation of the old acetabular fractures.