腹直肌外侧入路治疗髋臼骨折合并同侧坐骨大切迹骨折的手术方法及疗效

Surgical technique and curative effect analysis of the lateral-rectus approach for acetabular fractures combined with ipsilateral greater sciatic notch fractures

目的探讨腹直肌外侧入路治疗髋臼骨折合并同侧坐骨大切迹骨折的手术方法及临床疗效。方法回顾性分析2015年1月至2021年1月采用单一腹直肌外侧入路钢板内固定治疗9例髋臼骨折合并同侧坐骨大切迹骨折患者资料,男7例、女2例;年龄(39.8±15.4)岁(范围25~54岁);坠落伤6例、车祸伤3例;合并骨盆骨折3例、颅脑损伤1例、胸部损伤3例、腹部闭合性损伤2例、四肢其他骨折3例。髋臼骨折依据Letournel-Judet分型均为双柱骨折;坐骨大切迹骨折均为骨折线自骶髂关节下方经坐骨大切迹顶至髋臼后柱且移位明显的骨折。术后行骨盆X线及CT检查,根据Matta影像学标准评价髋臼及坐骨大切迹骨折的复位质量,采用Matta改良的Merle d'Aubigné-Postel评分评估髋关节功能。结果9例患者均顺利完成手术并获得随访,手术时间(140.4±55.2)min(范围110~190 min),术中出血量(770.5±430.9)ml(范围540~1260 ml)。术后Matta影像学骨折复位质量评价,解剖复位7例、满意复位2例。随访时间(24.8±8.8)个月(范围12~36个月)。髋臼骨折及坐骨大孔骨折均愈合良好,愈合时间6~12周,无一例发生骨折复位丢失、内固定失效、创伤性关节炎、股骨头坏死等并发症。术后1年,Matta改良的Merle d'Aubigne-Postel髋关节功能评分为(16.2±0.6)分(范围12~18分),其中优6例、良2例、可1例,优良率89%。结论髋臼骨折合并坐骨大切迹骨折损伤严重,手术复位固定较为困难;腹直肌外侧入路能较好地完成骨折复位和固定,并可获得满意的治疗效果。

Objective To explore the surgical technique and clinical results of the lateral-rectus approach(LRA)for acetabular fractures combined with ipsilateral greater sciatic notch fractures.Methods Nine cases of acetabular fractures combined with ipsilateral greater sciatic notch fractures treated by the LRA from January 2015 to January 2021 were involved in this study,including 7 males and 2 females with age of 39.8±15.4 years(range,25-54 years).Six cases were injured by falling and the others by traffic accidents.There were 3 cases combined with pelvic fractures,1 combined with craniocerebral injury,3 combined with thoracic injury,2 combined with closed abdominal injury,and 3 combined with other fractures of the extremities.Based on the Letournel-Judet classification,the cases were all classified as double-column acetabular fractures.The fractures of the greater sciatic notch are all fractures with obvious displacement from the lower part of the sacroiliac joint through the top of the greater sciatic notch to the posterior column of the acetabulum.Pelvic X-ray and CT examination were performed after operation.The reduction quality of the acetabulum and greater sciatic foramen was evaluated by Matta's criteria.The function of the hip joint was assessed by modified Merle D'Aubigné-Postel score.Results All 9 patients were successfully completed the operation,and followed up.The operation time was 140.4±55.2 min(range,110-190 min).The amount of intraoperative blood loss was 770.5±430.9 ml(range,540-1,260 ml).All cases of fractures had healed in 7.7±3.4 weeks(range,6-12 weeks)after operation.According to Matta's reduction quality criteria,the quality of fracture reduction after surgery was excellent in 7 cases and good in 2 cases.The follow-up period was 24.8±8.8 months(range,6-12 months).Fractures of the acetabulum and greater sciatic foramen healed well,with the healing time of 6 to 12 weeks.There were no complications such as loss of fracture reduction,failure of internal fixation,traumatic arthritis or necrosis of femoral head.Matta's modified Merle d'Aubigne-Postel hip function score was 16.2±0.6(range,12-18)one year after surgery.There were excellent in 6 cases,good in 2 cases,fair in 1 case,with an excellent and good rate of 89%.Conclusion Fractures of the acetabulum and ipsilateral greater sciatic notch are serious injuries with difficulty in surgical reduction and fixation.The LRA can better complete reduction and fixation of the above fractures,obtaining satisfactory clinical outcomes.