腹直肌旁入路髋臼下通道螺钉固定复杂髋臼骨折

Infra-acetabular screw through the pararectus approach for fixation of complex acetabular fractures

[目的]介绍腹直肌旁入路髋臼下通道螺钉固定复杂髋臼骨折的手术与治疗技术和初步临床结果。[方法]2019年7月—2022年6月经腹直肌旁入路应用髋臼下通道螺钉治疗的14例复杂髋臼骨折患者。经单一经腹直肌旁入路下复位固定,沿骨盆界限上缘放置重建钢板固定前柱骨折;通过髂坐钢板或梳状螺钉固定四边体;通过腹直肌旁入路第3窗在髂耻隆起偏尾端偏内侧指向坐骨结节置入1枚直径3.5 mm或4.5 mm髋臼下通道螺钉。[结果]患者均顺利完成手术,术中无血管、神经损伤,手术时间平均(153.5±45.6)min,术中出血量平均(465.7±249.5)ml。随访时间平均(14.5±4.7)个月;采用Matta方法评价骨折复位质量,优12例,良2例,末次随访Merled'Aubigne-Postel评分为14~18分,其中优9例,良4例,可1例。[结论]采用单一经腹直肌旁入路复位固定复杂髋臼骨折,其中使用髋臼下通道螺钉固定前后柱以增强整体内固定稳定性,能够取得满意的临床效果。

[Objective]To introduce the surgical techniques and preliminary clinical results of fixation of complex acetabular fractures through the pararectus approach.[Methods]From July 2019 to June 2022,a total of 14 patients received infra-acetabular screw fixation of complex acetabular fractures through the pararectus approach.Through the pararectus approach,the anterior column fracture was reduced and fixed by a reconstructive plate along the upper boundary of the pelvis,with the quadrilateral body fixed by iliac plate or comb screws.In addition,an infra-acetabular screw 3.5mm or 4.5mm in diameter was inserted at the medial end of the iliopectineal eminence towards the ischiatic tubercle through the third window of the para-rectus approach.[Results]All the patients had operation performed successfully without vascular or nerve injury,whereas with an average operation time of(153.5±45.6)min,and an average intraoperative blood loss of(465.7±249.5)ml.Based on Matta criteria,the quality of fracture reduction was excellent in 12 cases and good in 2 cases.The Merled'Aubigne-Postel score ranged from 14 to 18 at the last follow-up lasted for(14.5±4.7)months in a mean,accordingly,9 cases were excellent,4 cases were good and 1 case was fair.[Conclusion]Fixation of complex acetabular fractures by a single para-rectus approach,in which the anterior and posterior columns are fixed with infra-acetabular screw to enhance the overall stability of the internal fixation,does achieve satisfactory clinical results.