经腹直肌外侧入路治疗髋臼前后柱骨折的疗效

The effect of lateral rectus abdominis approach for acetabular anterior and posterior columns fracture

目的探讨经腹直肌外侧入路治疗髋臼前后柱骨折的疗效。方法采用经腹直肌外侧入路治疗18例髋臼前后柱骨折患者。记录手术时间、术中出血量、术后并发症发生情况及骨痂形成情况、骨折愈合情况。采用Matta影像学评估标准评价骨折复位质量。采用改良的Merle D′Aubigne Postel评分系统对髋关节功能进行评价。结果患者均获得随访,时间13~78(35.2±15.4)个月。手术时间75~160(122.3±23.1)min,术中出血量150~600(339.3±115.7)min。术后48 h时按照Matta影像学评估标准评价骨折复位质量:优13例,良3例,差2例,优良率16/18。术后1例出现腹壁切口皮下脂肪液化,经积极换药后愈合。术后无感染、腹股沟疝及异位骨化等并发症发生。骨痂开始形成时间6~9(8.1±1.1)周。骨折均愈合良好,时间10~14(12.3±1.2)周。术后6个月采用改良的Merle D′Aubigne Postel评分系统对髋关节功能进行评价:优14例,良2例,可2例,优良率16/18。结论经腹直肌外侧入路治疗髋臼前后柱骨折,具有切口小、术中显露充分、术中出血量少、手术时间短、术后并发症少的优点,且骨折复位优良率较高,患者术后功能恢复较好。

Objective To investigate the effect of lateral rectus abdominis approach in the treatment of acetabular anterior and posterior columns fractures.Methods Eighteen patients with acetabular anterior and posterior columns fractures were treated with the lateral rectus abdominis approach.The operation time,intraoperative blood loss,the situation of postoperative complications,callus formation,and fracture healing were recorded.Matta imaging evaluation criteria were used to evaluate the quality of fracture reduction.The improved Merle D′Aubigne Postel scoring system was used to evaluate hip joint function.Results All patients were followed up for 13~78(35.2±15.4)months.The operation time was 75~160(122.3±23.1)min,and the intraoperative blood loss was 150~600(339.3±115.7)min.At 48 h postoperation,the quality of fracture reduction was evaluated according to Matta imaging evaluation criteria:excellent in 13 cases,good in 3 cases,and poor in 2,the excellent-good rate was 16/18.After surgery,subcutaneous fat liquefaction occurred in 1 case of abdominal incision,which healed after active dressing change.No complications such as infection,inguinal hernia and heterotopic ossification occurred after the operation.The start time of callus formation was 6~9(8.1±1.1)weeks.All fractures healed well within 10~14(12.3±1.2)weeks.At 6 months after operation,the improved Merle D′Aubigne Postel scoring system was used to evaluate hip joint function:14 cases were excellent,2 cases were good,2 cases were fair,and the excellent and good rate was 16/18.Conclusions Lateral rectus abdominis approach for the treatment of acetabular anterior and posterior columns fractures has the advantages of small incision,adequate intraoperative exposure,less intraoperative blood loss,short operation time,few postoperative complications,and higher excellent rate of fracture reduction.The patient′s postoperative functional recovery is good.