二腹肌大转子截骨对合并髋关节脱位的高位髋臼后壁骨折的疗效

Clinical outcome of open reduction and internal fixation with digastric trochanteric flip osteotomy for acetabular posterior wall fracture with hip dislocation

目的探讨应用二腹肌大转子截骨治疗合并髋关节脱位的高位髋臼后壁骨折的临床疗效。方法回顾性分析2014年1月至2016年12月在北京积水潭医院住院治疗的39例高位髋臼后壁骨折合并关节脱位患者的临床资料,按手术方式分为截骨组(22例)和对照组(17例)。截骨组患者采用Kocher-Langenbeck(K-L)入路联合二腹肌大转子截骨进行手术,对照组采用单纯K-L入路进行手术。分别记录比较两组患者围手术期相关指标及并发症情况,术后采用Matta标准评价骨折复位程度,采用髋部骨折功能恢复量表(FRS)以及欧洲五维健康量表(EQ-5D)评价手术疗效。结果两组患者一般资料具有可比性,术后随访(48±11)个月。住院期间所有患者均顺利完成手术,两组患者手术时间、术中出血量、住院日及并发症发生率差异均无统计学意义(t=1.31、1.52、1.22,χ^(2)=2.02,均P>0.05)。虽然截骨组骨折复位优良率与对照组相当(95.5%比88.2%,χ^(2)=0.05,P=0.81),但截骨组复位优的比例较高,患者FRS评分及EQ-5D指数均明显优于对照组[(85±13)比(80±15)分和0.86±0.12比0.80±0.17,t=2.87、3.47,均P<0.05]。结论K-L入路联合二腹肌大转子截骨治疗合并髋关节脱位的高位髋臼后壁骨折有利于术野的暴露和操作,与传统K-L入路相比临床疗效更为满意。

Objective To evaluate the clinical outcome of open reduction and internal fixation via digastric trochanteric flip osteotomy for acetabular posterior wall fracture with hip dislocation.Methods From January 2014 to December 2016 a total of 39 patients who suffered posterior wall acetabular fracture and hip dislocation and treated in Beijing Jishuitan Hospital were included in this retrospective study.All the patients were divided into two groups according to surgery type.There were 22 cases in osteotomy group who underwent digastric trochanteric flip osteotomy(DTFO)via Kocher-Langenbeck(K-L)approach,while 17 cases in control group who only received surgery via(K-L)approach.The Matta scale was used to evaluate fracture reduction,while functional recovery scale(FRS)and Euro-Quality of 5 Dimension(EQ-5D)were applied to measure the clinical effect.Results The baseline characteristics were similar for both groups and the mean follow-up period was(48±11)months.All the surgeries were performed successfully.The blood loss(t=1.52,P=0.12),bed days(t=1.22,P=0.25),complication rate(χ^(2)=2.02,P=0.16)and operation time(t=1.31,P=0.23)showed no significant difference between the 2 groups(P>0.05).The fracture reduction(χ^(2)=0.05,P=0.81)were similar between the 2 groups but the excellent rate were higher in osteotomy group.According to evaluation scales the FRS score and EQ-5D index favored osteotomy group(85±13 vs 80±15 and 0.86±0.12 vs 0.80±0.17,respectively,t=2.87,3.47,both P<0.05).Conclusion K-L approach with DTFO can provide clearier surgical field which is convenient for procedure,and compared to K-L approach the clinical effect is more satisfactory.