前路经腹直肌外侧小切口入路治疗髋臼骨折的临床疗效观察

Clinical effect of anterior approach through lateral incision of rectus abdominis in treatment of acetabular fracture

目的探讨前路经腹直肌外侧小切口入路治疗髋臼骨折的临床疗效。方法回顾性分析2017年10月至2019年10月我院骨科采用前路经腹直肌外侧小切口入路治疗的19例髋臼骨折病人的临床资料,其中男11例,女8例,平均年龄为33.7岁(22~66岁);交通事故损伤13例,建筑工地坠落伤5例,重物挤压伤1例。骨折按Judet-Letournel分型,前柱伴后半横形骨折3例,前柱骨折11例,双柱骨折5例。术后定期进行骨盆影像学检查,术后1周按Matta影像学评估标准评价骨折复位情况;术后24周采用改良的Merle dAubigné和Harris评分系统评价髋关节功能。结果病人均顺利完成手术。术后1周骨折复位愈合情况:解剖复位13例,复位满意4例,复位不满意2例,满意率为89.5%。术后24周髋关节功能:优13例,良5例,可1例,总优良率为94.7%。结论前路经腹直肌外侧小切口入路显露髋臼前方充分,骨折复位满意度高,创伤小、恢复快,术后功能优,值得临床推广。

Objective To explore the clinical efficacy of the treatment of acetabular fractures by means of lateral incision of rectus abdominis through the anterior approach.Methods The clinical data of 19 patients with acetabular fractures treated by the lateral rectus abdominis through the anterior approach in our hospital from October 2017 to October 2019 were analyzed retrospectively.There were 11 male cases and 8 female cases,aged 22 to 66 years old,with an average age of 33.7 years old.There were 13 cases of traffic accident injuries,5 cases of construction site falls,and 1 case of heavy object crush injuries.Fractures were classified according to Judet-Letournel:anterior column with posterior semi-transverse fracture in 3 cases,anterior column fracture in 11 cases,and double-column fracture in 5 cases.Periodic follow-up was conducted by pelvic imaging examination to evaluate fracture reduction according to Matta imaging evaluation criteria one week after surgery.The modified Merle d’Aubignéand Harris scoring system was used for hip function evaluation 24 weeks after surgery.Results All patients in this study completed the operation successfully.One week after surgery,13 cases obtained anatomical reduction,4 cases were satisfied with reduction,and 2 cases were dissatisfied with reduction.The satisfaction rate was 89.5%.Hip function at 24 th week after surgery was excellent in 13 cases,good in 5 cases,and fair in 1 case.The overall excellent and good rate was 94.7%.Conclusion The through lateral incision of rectus abdominis through the anterior approach showed that the place ahead of the acetabulum was adequate,satisfaction of fracture reset was high,with small trauma and fast recovery,and the postoperative function was excellent.