髋臼骨折手术入路选择的原则与复位固定技巧

Selection of operative approaches and reduction and fixation techniques for acetabular fractures

髋臼骨折属于关节内骨折,其治疗原则也等同于关节内骨折的治疗原则,即关节面的解剖复位、坚强固定,因此手术入路的选择对髋臼骨折的手术显露、复位质量、固定效果等至关重要,直接影响手术疗效。合适的手术入路不仅显露清晰,便于手术操作,可达到较理想的复位质量和固定效果,而且在缩短手术时间、减少术中出血、减小手术创伤及避免手术并发症等方面均有较大优势。髋臼骨折的手术入路选择与骨折的损伤机制、骨折分型、临床表现等密切相关,手术疗效取决于骨折复位质量、固定效果及手术创伤程度等,而这些均与手术入路的选择密切相关。目前可供选择的手术入路大致分为前方入路和后方入路;但由于髋臼骨折的复杂性,没有一种手术入路能解决所有的髋臼骨折,而且每种入路均有其各自的适应证、优势及不足。

Acetabular fracture is an intra-articular fracture,and its treatment principle is also equivalent to that of intra-articular fracture,namely anatomical reduction of articular surface and firm fixation.Therefore,the choice of surgical approach is of great importance to the surgical exposure,reduction quality and fixation effect of acetabular fracture,which directly affects the surgical curative effect.Proper surgical approach is not only good for clear surgical exposure,easy operation,and ideal reduction quality and fixation effect,but also has great advantages in shortening the operation time,reducing intraoperative bleeding,reducing surgical trauma and avoiding surgical complications.The selection of surgical approach for acetabular fractures is closely related to the fracture injury mechanism,fracture classification,and clinical manifestations,etc..The surgical efficacy depends on the fracture reduction quality,fixation effect,and surgical trauma degree,etc.,which are closely related to the selection of surgical approach.At present,the alternative surgical approaches are generally divided into anterior approach and posterior approach.However,due to the complexity of acetabular fractures,no single surgical approach can fit all acetabular fractures,and each approach has its own indications,advantages and disadvantages.