经髂腹股沟入路内侧窗内固定治疗髋臼前柱或耻骨支骨折

Treatment of acetabular anterior column or pubic ramus fractures with internal fixation via the medial window of the ilioinguinal approach

目的:探讨经髂腹股沟入路内侧窗切开复位内固定治疗髋臼前柱或耻骨支骨折的手术技巧及临床疗效。方法:回顾性分析2017年1月至2022年1月采用髂腹股沟入路内侧窗切开复位内固定治疗的32例髋臼前柱或耻骨支骨折还在,其中髋臼前柱骨折14例,耻骨支骨折18例。术中均采用髂腹股沟入路内侧窗,即于耻骨结节上方沿耻骨支作3~5 cm横行切口,骨膜下剥离显露髋臼前柱或耻骨支骨折,骨折复位后沿骨盆界线放置重建钛板。将螺钉斜向置入髋臼顶部上方固定重建板的近端,将螺钉置入骨性耻骨联合和耻骨支固定重建板的远端。结果:术后骨折复位质量按Matta评分为:优24例,良6例,差2例,优良率为93.8%。32例患者均获得随访,随访时间为6~24个月,平均(10.9±4.8)个月,所有患者骨折均愈合。末次随访时髋关节功能按改良的D’Aubigne-Postel评分系统:优21例,良6例,可5例,优良率为84.4%。骨盆术后功能按照Majeed评分:优22例,良7例,可3例,优良率为90.6%。1例患者术后出现切口脂肪液化,经延迟拆线并换药后愈合。其余患者随访期间均无血管神经损伤、感染、异位骨化、股骨头坏死、腹股沟疝、切口疝等并发症发生。结论:经髂腹股沟入路内侧窗可有效复位固定髋臼前柱或耻骨支骨折,手术时间短,固定可靠,术中出血量少,创伤小,并发症少,可取得良好的临床疗效。

Objective:To investigate the surgical technique and clinical efficacy of open reduction and internal fixation via the medial window of the ilioinguinal approach for acetabular anterior column or pubic ramus fractures.Methods:A retrospective analysis was conducted on 32 cases with acetabular anterior column or pubic ramus fractures treated with open reduction and internal fixation through the medial window of the ilioinguinal approach between January 2017 and January 2022,including 14 cases with acetabular anterior column fracture and 18 cases with pubic ramus fracture.The medial window of the ilioinguinal approach was used during the operation,with a transverse incision of 3-5 cm made above the pubic tuberosity along rami ossis pubis.Acetabular anterior column or pubic ramus fractures were exposed by subperiosteal dissection.After the fracture was reduced,a reconstruction titanium plate was placed along the pelvic brim.The proximal screws were placed obliquely above the acetabular roof,while the distal screws were placed in the bony symphysis pubis and ramus pubis to secure the reconstructive plate.Results:According to the Matta score,the quality of postoperative fracture reduction was excellent in 24 cases,good in 6 cases and fair in 2 cases.The excellent and good rate was 93.8%.All 32 patients were followed up for 6-24 months,and all the fractures healed.At the last follow-up,according to the modified D'Aubign-Postel scoring system,the hip function was excellent in 21 cases,good in 6 cases and fair in 5 cases,with an excellent and good rate of 84.4%.According to Majeed score,the postoperative pelvic function was excellent in 22 cases,good in 7 cases and fair in 3 cases,with an excellent and good rate of 90.6%.One patient experienced incision fat liquefaction after operation,which healed after delayed suture removal and dressing change.No complications such as vascular and nerve injury,infection,ectopic ossification,necrosis of femoral head,inguinal hernia,or incisional hernia,occurred during the follow-up.Conclusions:Surgical treatment through the medial window of the ilioinguinal approach can effectively reduce and fix acetabular anterior column or pubic ramus fractures.This approach offers advantages such as shorter operation time,less intraoperative blood loss,minimal trauma,and fewer complications,and can achieve good clinical efficacy.