复杂髋臼骨折复位与微创固定

Reduction and minimally invasive fixation for complex acetabular fracture

目的探究复杂髋臼骨折复位与微创固定方法,评价微创固定技术的治疗效果。方法对2011年3月至2015年6月郑州市骨科医院收治的58例复杂髋臼骨折(横行伴后壁骨折18例、前柱伴后半横行骨折19例、"T"形骨折11例、双柱骨折10例)患者,采用后路K-L入路联合前方髂腹股沟微创插板入路,分别进行髋臼重建钢板和螺钉前后固定。结果随访9~59个月,平均随访时间28.5个月。术后骨折复位情况按照Matta标准评估,解剖复位28例、满意复位23例、不满意复位7例,总体复位满意率为88%;术后8个月髋关节功能采用D'Aubigne和Postel标准评估:优30例、良18例、可6例、差4例,总体优良率为83%。远期并发症包括异位骨化Brooker分级Ⅰ~Ⅱ度7例、Ⅲ度3例、Ⅳ度2例(无一例发生骨不连),骨关节炎2例,股骨头缺血性坏死1例。结论后路K-L入路联合前方髂腹股沟微创插板入路复位固定技术可用于治疗复杂髋臼骨折,具有创伤轻微、操作简单、疗效显著等特点。

Objective To explore the methods of reduction and minimally invasive fixation,and to evaluatethe therapeutic effect of minimally invasive fixation technique.Methods A total of58patients with complexacetabular fractures,including18of transverse and posterior wall fracture,19of anterior column and posteriorhemi-transverse fracture,11of T-shape fracture and10of both-column fracture,were treated surgically inZhengzhou Orthopedics Hospital from March2011to June2015.They all underwent acetabular reconstructionplate and screw fixation through posterior K-L approach combined with anterior ilioinguinal minimally invasiveinserting plate approach.Results All patients were followed up for9to59months,with an average time of28.5months.Reduction of fracture was evaluated according to Matta clinical outcome criteria,anatomical reductionwas obtained in28cases,satisfactory reduction in23,and unsatisfactory reduction in7cases,with the total satisfactory reduction rate of88%.At8months after the operation,hip function was evaluated by D'Aubigne andPostel criteria,there were excellent in30cases,good in18,fair in6and poor in4cases,with the total excellentand good rate of83%.Long-term complications were as follows,heterotopic ossification in12cases(7ofBrooker gradeⅠ-Ⅱ,3of gradeⅢ,and2of gradeⅣ)without bone nonunion,osteoarthritis in2cases andavascular necrosis of femoral head in1case.Conclusion Reduction and fixation through posterior K-L approachcombined with anterior ilioinguinal minimally invasive inserting plate approach is a feasible method,with theadvantages of less trauma,simple procedures and satisfactory curative effect.