单一髂腹股沟入路治疗髋臼双柱合并 后壁骨折的早期临床疗效分析
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潍坊市人民医院

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Single iliac-groin approach for the treatment of acetabular double-column combination Analysis of early clinical curative effect of posterior wall fracture
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1.Weifang People'2.'3.s Hospital

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    摘要:

    [目的]评估在髂腹股沟入路下髋臼双柱合并后壁骨折后壁骨块未予固定的临床疗效。[方法]2016年5月-2021年1月在髂腹股沟入路下治疗髋臼双柱合并后壁骨折的30例患者的临床资料;男17例,女13例;年龄22-76岁,平均(41.4±15.5)岁;Judet?Letournel髋臼分型均为髋臼双柱合并后壁骨折,手术在全麻下采用髂腹股沟入路进行,髂骨翼骨折处采用钢板或拉力螺钉固定,前柱采用钢板固定,后柱采用后柱拉力螺钉固定,后壁不予固定;随访时髋关节功能采用Matta改良的Merle d’Aubigne?Postel评分系统评价,采用Matta方法评价髋臼骨折复位情况;记录患者的手术时间,出血量,骨折再移位,感染等情况。[结果]随访时间8-58个月,30例患者均获得随访,平均(25.5±10.6)个月;手术时间:90-300min,平均(140.5±30.3)min;术中出血500-3000ml,平均(805.4±500.7)ml;术后随访过程中后壁骨折块无一例发生再移位情况。Matta方法评价骨折复位质量:优10例,良16例,差4例,优良率86.7%(26/30);末次随访,Merle d’Aubigne?Postel评分13-18分,平均(16.8±1.2)分,优9例,良18例,可3例,优良率90.0%(27/30);术后8例患者出现股外侧皮神经症状,至末次随访仍有2例症状未消失;1例出现切口脂肪液化,经清创换药后愈合,2例出现下肢深静脉血栓,服用利伐沙班抗凝治疗;无一例出现异位骨化,坐骨神经损伤,再手术等。[结论]在髋臼双柱合并后壁骨折的类型中后壁骨块未予固定也能取得良好的临床效果。

    Abstract:

    [Objective] To evaluate the clinical efficacy of unfixed acetabular double column combined with posterior wall fracture under the iliac-groin approach. [Method] From May 2016 to January 2021, the clinical data of 30 patients with acetabular double-column combined posterior wall fracture treated under the iliac-groin approach; 17 males and 13 females; age 22-76 years old, average (41.4±15.5) years old; Judet-Letournel acetabular classification is all acetabular double-column combined with posterior wall fractures. The operation is performed under general anesthesia using an iliac-groin approach, and the iliac wing fractures are fixed with steel plates or lag screws. The column was fixed with a steel plate, the posterior column was fixed with a posterior lag screw, and the posterior wall was not fixed. During follow-up, the hip joint function was evaluated using Matta''s modified Merle d''Aubigne-Postel scoring system, and the Matta method was used to evaluate the reduction of acetabular fractures; The patient''s operation time, blood loss, fracture displacement, infection, etc. [Results] The follow-up time was 8-58 months. All 30 patients were followed up with an average of (25.5±10.6) months; operation time: 90-300min, average (140.5±30.3) min; intraoperative bleeding 500-3000ml, average (805.4±500.7) ml; no case of posterior wall fracture occurred re-displacement during the postoperative follow-up. The quality of fracture reduction evaluated by Matta method: excellent in 10 cases, good in 16 cases, poor in 4 cases, the excellent and good rate was 86.7% (26/30); at the last follow-up, Merle d''Aubigne-Postel score was 13-18 points, average (16.8±1.2) 9 cases were excellent, 18 cases were good, 3 cases were fair, and the excellent and good rate was 90.0% (27/30); 8 cases had lateral femoral cutaneous nerve symptoms after surgery, and 2 cases had not disappeared at the last follow-up; 1 case had symptoms The incision was fat liquefied and healed after debridement and dressing change. 2 cases developed deep venous thrombosis of the lower extremities and were treated with rivaroxaban anticoagulant therapy; none of the cases developed heterotopic ossification, sciatic nerve injury, and reoperation. [Conclusion] In the type of acetabular double-column combined with posterior wall fracture, the posterior wall bone block can also achieve good clinical results without fixation.

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  • 收稿日期:2021-09-15
  • 最后修改日期:2021-09-15
  • 录用日期:2022-02-15
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