腹直肌外侧入路结合翼状接骨板治疗髋臼骨折21例疗效分析

21 Cases Analysis of Curative Effect of Lateral Rectus Abdominis Approach Combined with Pterygoid Plate in the Treatment of Acetabular Fractures

目的:探讨应用腹直肌外侧入路结合翼状接骨板治疗髋臼骨折的临床疗效和安全性。方法:回顾性分析2021年5月至2023年3月采用腹直肌外侧入路治疗的21例髋臼骨折患者,男16例,女5例;平均年龄为46岁(29~62岁)。按Letournel-Judet分型:前柱骨折8例,前柱合并后半横行骨折5例,横行骨折4例,T形骨折4例。交通事故伤7例,高处坠落伤8例,跌伤6例。3例合并桡骨远端骨折,5例合并多发肋骨骨折和肺挫伤,2例合并肾挫伤。均采用腹直肌外侧入路结合翼状接骨板固定治疗,术后采用Matta标准评价骨折复位质量,同时记录治疗及随访期间的并发症情况。结果:21例获得3~21个月随访,平均为8个月。根据Matta标准:解剖复位18例,满意复位3例。根据Merle d’Aubigne-Postel髋关节功能评分:优16例,良4例,可1例。结论:腹直肌外侧入路结合翼状接骨板治疗髋臼骨折操作安全,出血少,术野清晰,骨折复位和固定相对容易,术后并发症少,值得临床推荐。

Objective:To investigate the clinical efficacy and safety of the lateral rectus abdominis approach combined with pterygoid plate in the treatment of acetabular fractures.Methods:21 cases of acetabular fractures were treated and retrospectively analyzed with the lateral rectus abdominis approach,including 16 males and 5 females,with an average age of 46 years old(2962 years old)from May 2021 to March 2023.According to the Letournel-Judet classification,there were 8 cases of anterior column fracture,5 cases of anterior column combined posterior semitransverse fracture,4 cases of transverse fracture,and 4 cases of T-shaped fracture.There were 7 cases of traffic accident injuries,8 cases of falls from heights,and 6 cases of fall injuries.There were 3 cases with distal radius fracture,5 cases with multiple rib fractures and lung contusion,and 2 cases with renal contusion.All patients were treated by lateral rectus abdominis approach combined with pterygoid plate fixation.The quality of fracture reduction was evaluated by Matta standard after operation,and the complications during treatment and follow-up were recorded.Results:21 cases were followed up for 3 to 21 months,with an average of 8 months.According to the Matta standard,18 cases were anatomically reduced while 3 cases were satisfactorily reduced.According to the Merle d'Aubigne-Postel hip function score,16 cases were excellent,4 cases were good,and 1 case was fair.Conclusion:The lateral rectus abdominis approach combined with pterygoid plate in the treatment of acetabular fractures has the characteristics of safe operation,less bleeding,clear operative field,relatively easy fracture reduction and fixation and fewer postoperative complications,is clinically recommended.