Kocher—Langenbeck入路联合部分近端Watson—Jones切口治疗涉及臼顶负重区的髋臼骨折

Kocher-Langenbeck approach combined with partial proximal Watson-Jones incision for acetabular fractures involving weight-bearing area

目的探讨Kocher—Langenbeck（K-L）入路联合部分近端Watson-Jones切口治疗涉及臼顶负重区的髋臼骨折的临床效果。方法回顾性分析2012年1月至2017年1月期间采用K—L入路联合部分近端Watson—Jones切口治疗的20例涉及臼顶负重区的髋臼骨折患者资料。男13例，女7例；年龄为22～67岁，平均40．7岁。骨折按照Letournel-Judet分型：后壁骨折8例，横形骨折1例，T形骨折1例，横形伴后壁骨折1例，后柱伴后壁骨折3例，双柱骨折6例。所有患者均采用切开复位钢板及螺钉内固定。术后随访根据Matta标准评估患者骨折复位质量，末次随访时根据改良的Merled’Aubigne＆Postel评分标准评定患髋功能，根据美国医学研究委员会标准评定外展肌力。结果20例患者术后获7—21个月（平均8．2个月）随访。本组患者骨折均获愈合，愈合时间为10～18周（平均11．4周），无骨折再移位、内固定物松动及深部感染等并发症发生。根据Matta标准评定骨折复位质量：解剖复位13例，满意复位6例，不满意复位1例，满意率为95％。末次随访时根据改良的Merled’Aubigne＆Postel评分标准评定患髋功能：优9例，良7例，可3例，差1例，优良率为80％。1例患者发生BrookerI级异位骨化。根据美国医学研究委员会标准评定外展肌力：4级3例，5级17例。结论采用K-L入路联合部分近端Watson—Jones切口可以增加臼顶部手术视野，有效提高股骨头与髋臼顶的解剖匹配率，降低复位和固定难度，疗效良好，为累及臼顶负重区的髋臼骨折的治疗提供了新的思路。

Objective To evaluate clinical outcomes of the Kocher-Langenbeck （K-L） approach combined with partial proximal Watson-Jones incision for the treatment of acetabular fractures involving the weight-bearing area. Methods From January 2012 to January 2017, 20 patients were treated by the K-L approach combined with partial proximal Watson-Jones incision for acetabular fracture involving the weight-bearing acetabular dome. They were 13 males and 7 females, with an average age of 40.7 years （range, from 22 to 67 years）. According to the Letournel-Judet classification, there were 8 posterior wall fractures, one transverse fracture, one T-shaped fracture, one transverse and posterior wall fracture, 3 posterior column and posterior wall fractures, and 6 double-column fractures. All patients received open reduction and internal fixation with plates and screws. The outcomes of reduction were evaluated at follow-ups according to the Matta criteria. The hip function was evaluated according to the modified Merle d＇Aubigne-Postel criteria and the abductor strength by the American Medical Research Council criteria at final follow-ups. Results All the 20 patients were followed up for an average of 8.2 months （range, from 7 to 21 months）. They all obtained bony union after 10 to 18 weeks （average, 11. d weeks） . No fracture displacement, internal fixation loosening or deep infection occurred. According to the Matta criteria, anatomic reduction was achieved in 13 cases, sat- isfactory reduction in 6 cases, and unsatisfactory in one （a satisfactory rate of 95% ） . The modified Merle d＇Aubigne-Postel scoring for the hip function at the final follow-ups yielded 9 excellent cases, 7 good cases, 3 fair cases and one poor case （an excellent to good rate of 80% ）. Ectopic ossification of Brooker grade Ⅰ occurred in one case. The abductor strength was rated as grade Ⅳ in 3 cases and as grade Ⅴ in 17. Conclusions In the treatment of acetabular fractures involving the acetabular dome, the K-L approach combined with partial proximal Watson-Jones incision can increase the operation view of the weight-bearing area, enhance the anatomic matching of femoral head and acetabular roof, and reduce the difficulties in reduction and fixation.