全腹腔镜技术治疗骨盆与髋臼骨折的临床疗效

Clinical effects of total laparoscopic technique in the treatment of pelvic and acetabular fractures

目的接探讨全腹腔镜技术治疗骨盆与髋臼骨折的临床疗效。方法回顾性分析2017年4月至2023年8月南京医科大学第一附属医院骨科收治的骨盆和髋日骨折患者7例,男5例、女2例,年龄(43.9+9.9)岁(范围27~56岁)。骨盆骨折1例,Tile分型B3型;髋臼骨折6例,Letournel分型横形2例、双柱1例、横形+前柱1例、前柱1例、"T"形1例。致伤原因:交通伤4例,高处坠落伤1例,摔伤1例,重物砸伤1例。记录患者的手术时间、术中出血量、血管、神经、膀胱、直肠等医源性损伤及术后并发症发生率。采用Matta影像学标准评估骨折的复位质量,采用改良的Merled'Aubigne-Postel评分评价髋关节功能。结果7例患者均顺利完成手术并获得随访,随访时间为12.0(7.0,72.0)个月(范围7~77个月)。手术时间为(251.1±80.2)min(范围150.0~370.0min),术中出血量为100.0(50.0,300.0)ml(范围50~350ml)。术中无一例出现神经、血管、膀胱及直肠损伤。术后骨盆X线和CT均未见内固定物进入关节。7例患者中解剖复位5例,满意复位2例。1例髋白横形骨折的患者后柱存在轻度的分离移位,但髋关节面整体平整,未见明显台阶,未予固定。1例骨盆骨折患者骨盆前环粉碎,移位严重,术中未达解剖复位,但骨盆前环为非关节内骨折,采用双侧钢板对骨折端进行固定,术后骨盆前环形态及稳定性恢复良好。末次随访时Merled'Aubigné-Postel评分为18.0(17.0,18.0)分(范围17.0~18.0分),其中优4例、良3例。本组7例患者均获得临床愈合,愈合时间为2.5(2.5,3.0)个月(范围1.0~3.0个月)。无一例发生骨折延迟愈合或不愈合。末次随访时无一例出现内固定断裂、切口及内固定感染及深静脉血栓形成等并发症。结论全腹腔镜技术治疗骨盆与髋臼骨折术中出血量少、手术创伤小,临床疗效满意,可作为骨盆和髋臼骨折微创治疗的新选择。

Objective To investigate the clinical efficacy of total laparoscopic technique in the treatment of pelvic and acetabular fractures.Methods A total of 7 patients with pelvic and acetabular fractures admitted to the First Affiliated Hospital of Nanjing Medical University from April 2017 to August 2023 were retrospectively analyzed.There were 5 males and 2 females,aged 43.9±9.9 years(range,27-56 years).There was 1 pelvic fracture(Tile B3)and 6 acetabular fractures,Letournel typing trans-verse in 2 cases,double column in 1 case,transverse combined anterior column in 1 case,anterior column in 1 case,and"T"shape in Icase.The causes ofinjury included trafic accident in 4 cases,falling from height in Icase,falling inIcase,and heavy object injury in 1 case.The operation time,intraoperative blood loss,iatrogenic injuries of blood vessels,nerves,bladder and rec-tum,and incidence of postoperative complications were recorded.Matta imaging criteria was used to evaluate the quality of frac-ture reduction,and the hip function was evaluated by modified Merle d'Aubigne-Postel score.Results All 7 patients were suc-cessfully operated and followed up for 12.0(7.0,72.0)months(range,7-77 months).The operation time was 251.1±80.2 min(range,150.0-370.0 min),and the intraoperative blood loss was 100.0(50.0,300.0)ml(range,50-350 ml).There was no nerve,blood vessel,bladder or rectum injury during operation.Postoperative pelvic X-ray and CT showed no internal fixation into the joint.Anatomic reduction was achieved in 5 cases and satisfactory reduction in 2 cases.One patient with a transverse acetabular fracture had a slight separation and displacement of the posterior column,but the acetabular articular surface was flat as a whole without obvious steps and was not fixed.One patient with pelvic fracture had a comminuted anterior pelvic ring with severe dis-placement and did not achieve anatomical repositioning intraoperatively,but the anterior pelvic ring was a non-intra-articular frac-ture,and the fracture ends were immobilized with bilateral plates,and the morphology and stability of the anterior pelvic ring recovered well after the operation.The Merle d'Aubigne-Postel score at the final follow-up was 18.0(17.0,18.0)points(range,17.0-18.0 points),with 4 excellent and 3 good cases.All 7 patients achieved clinical healing with a healing time of 2.5(2.5,3.0)months(range,1.0-3.0 months).No delayed union or nonunion occurred.At the last follow-up,there were no complications such as internal fixation fracture,incision and internal fixation infection,and deep vein thrombosis.ConclusionTotal laparoscopic technique for the treatment of pelvic and acetabular fractures has less intraoperative blood loss,less surgical trauma,and satisfactory clinical efficacy.It can be used as a new choice of minimally invasive treatment of pelvic and acetabular fractures。