应用单一髂腹股沟入路治疗复杂髋臼骨折的疗效分析
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Operative efficacy of single ilioinguinal approach for compound acetabular fracture
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    目的:探讨应用髂腹股沟入路治疗复杂髋臼骨折的方法及临床疗效。方法:回顾性分析2011年9月至2015年10月,采用髂腹股沟入路手术治疗,并获得随访的13例复杂髋臼骨折的患者资料。其中男性10例,女性3例;年龄24~58岁,平均36.8岁;伤后至手术时间5~13 d,平均8 d;骨折按Letournel-Judet分型:双柱骨折8例,前方伴后半横型骨折3例,T型骨折2例。术中通过髂腹股沟入路复位固定前后柱,术后按照Matta复位标准评估复位质量,按照改良的D’Aubigne-Postel评分标准评价髋关节功能。结果:13例患者均获得随访,随访时间8~49个月,平均23.4个月。术后按照Matta复位标准评估复位质量,优8例,良4例,差1例,优良率92.3%;按照改良的D’Aubigne-Postel评分标准评价髋关节功能,优7例,良4例,差2例,优良率84.6%。2例发生伤口脂肪液化,1例经换药后愈合,1例经手术室再次清创后愈合。1例术后拔除引流管后管口持续渗血,经腹带加压输血及应用止血药后创面愈合。4例发生股外侧皮神经损伤,均于术后3个月到半年逐渐减轻并恢复。1例复位差的患者于术后半年发生创伤性关节炎。结论:正确评估髋臼骨折类型,周密的术前计划,术中仔细操作,通过髂腹股沟入路,可以对前方伴后方横行骨折、大部分双柱骨折及部分T型骨折进行复位及固定,并获得满意的临床疗效。

    Abstract:

    Objective:To probe into the operative techniques and clinical outcomes of treating compound acetabular fractures through single ilioinguinal approach. Methods:From September 2011 to October 2015,13 cases of compound acetabular fractures undergoing operation were followed up. Of them,there were 10 males and 3 females with an average age of 34.8 years. The interval between injury and surgery was 5 to 13 days,with an average of 8 days. All the cases underwent operation by single ilioinguinal approach. Results:All the 13 cases were followed up,and the mean follow-up period was 23.4(8 to 49) months. All the cases were evaluated by Matta reduction criteria and the modified D’Aubigne and Postel clinical scoring. Matta reduction criteria were excellent in 8 patients,good in 4 and poor in 1. D’Aubigne and Postel clinical scoring were excellent in 7 patients,good in 4 and poor in 2. There was complica-tion of fat liquefaction in 2 cases,one cured by changing dressing and the other by surgery. Another complication was continuing bleeding,cured by blood transfusion and pressure dressing. There was damage of lateral femoral cutaneous nerve in 4 cases,which became better in the following 3 to 6 months. There was traumatic arthritis in 1 case after surgery. Conclusion:Acetabular fractures associate with anterior and posterior hemi-transverse fractures;both column fractures and T shape fractures can be treated through single ilioinguinal approach which can result in satisfactory functional outcomes by preoperative planning and careful operation.

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孙晓,殷建,霍永峰,于健,殷照阳.应用单一髂腹股沟入路治疗复杂髋臼骨折的疗效分析[J].重庆医科大学学报,2018,(10):1360-

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  • 在线发布日期: 2019-05-06
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