经腹直肌外侧入路治疗髋臼横行骨折的疗效观察

Therapeutic effect of lateral approach of rectus abdominis for acetabular transverse fracture

目的探讨经腹直肌外侧入路治疗髋臼横行骨折的疗效。方法 2014年1月-2016年1月新乡市长垣县河南宏力医院收治16例髋臼横行骨折患者,男性11例,女性5例;年龄为29~58岁,平均39岁。根据Letournel-Judet骨折分型系统简单分型,依据髋臼骨折线位置分为经顶骨折6例,顶旁骨折7例,顶下骨折3例;3例合并四肢骨折,4例合并其他脏器损伤。均经腹直肌外侧入路行切开复位内固定治疗,记录手术所需时间和术中出血量,采用Matta骨折复位标准评价骨折复位情况,临床评估采用改良Merle d’Aubigng和Postel评分。结果手术切口长度平均7.0cm(6.0~9.0cm),手术平均时间105min(96~188min),术中出血量平均400mL(200~800mL)。所有患者获得平均26个月随访(3~49)个月。按照Matta骨盆髋臼骨折复位标准评定:优9例,良3例,可3例,差1例,优良率87.5%。骨折愈合时间平均12周。改良Merle d’Aubigne和Postel评分,优9例,良3例,可2例,差2例,优良率82.1%。5例患者术后闭孔神经损伤加重,4周后完全恢复。术后末次随访均未发现腹壁疝、切口感染或延期愈合等并发症发生。结论经腹直肌外侧入路治疗骨盆髋臼横行骨折具有术中窗口显露充分、操作容易、并发症少等优点,值得应用和推广。

Objective To evaluate the efficacy of lateral approach of the rectus abdominis for the treatment of acetabular transverse fractures.Methods From Jan.2014 to Jan.2016,16 patients with acetabular transverse fractures were enrolled,including 11 males and 5 females.The age ranged from 29 to 58 years,with an average of 39 years.On the basis of simple classification of the Letournel-Judet fracture classification system,according to the location of the acetabular fracture line,there were 6 cases of apical fracture,7 cases of apical fracture,3 cases of subvertebral fracture,3 cases of fracture with four limbs,and 4 cases with other organs damage.All patients underwent open reduction and internal fixation through the lateral approach of rectus abdominis.The time required for surgery and intraoperative blood loss were recorded.The fracture reduction was evaluated by the Matta fracture reduction criteria.The modified Merle d’Aubigng and Postel scores were used for clinical evaluation.Results The average length of the surgical incision was 7.0 cm(6.0-9.0 cm),the average operation time was 105 min(96-188 min),and the intraoperative blood loss was 400 mL(200-800 mL).All patients received an average follow-up of 26 months(3 to 49 months).According to the reduction criteria of the anterior acetabular fracture of the Matta pelvis,the result was excellent in 9 cases,good in 3 cases,fair in 3 cases,and poor in 1 case,and the excellent and good rate was 87.5%.The fracture healing time averaged 12 weeks.The improved Merle d’Aubigng and Postel scores were excellent in 9 cases,good in 3 cases,fair in 2 cases,and poor in 2 cases.The excellent and good rate was 82.1%.Five patients had aggravated obturator nerve injury and recovered completely after 4 weeks.No complication such as abdominal wall hernia,wound infection or delayed healing were found at the last follow-up.Conclusion Lateral approach of the rectus abdominis for the treatment of pelvic acetabular transverse fractures has the advantages of adequate intraoperative window,easy operation and less complications.It is worthy of application and promotion.