微创经皮桥接钢板技术治疗真骨盆缘完整的髋臼前柱骨折的疗效分析

摘要

目的:探讨微创经皮桥接钢板技术治疗真骨盆缘完整的髋臼前柱骨折的可行性和疗效分析.方法:对2013年5月至2015年12月收治的8例真骨盆缘完整的髋臼前柱骨折患者进行回顾性分析,根据Judet-Letournel分型,均为单纯的髋臼前柱不稳定骨折.其中男5例,女3例;年龄22～63岁,平均42.8岁;挤压伤4例,压砸伤3例,高处坠落伤1例.受伤至手术时间5～19d,平均9.5 d.术前CT显示髋臼高位前柱骨折,骨盆真骨盆缘完整,骨折端分离均＜1 cm.所有患者采用闭合复位微创经皮桥接钢板固定技术治疗.观察并记录患者的骨折复位质量、手术时间、术中出血量、骨折愈合时间、末次随访时的髋关节功能及术后并发症发生情况等.结果:8例患者均获得随访,时间10～19个月,平均14.5个月.依据Matta影像学评分标准评定骨折复位质量,解剖复位4例,复位良好3例,复住较差1例.手术时间30～80 min,平均51.3 min;术中出血量50～120 ml,平均86.2 ml;骨折愈合时间10～19周,平均13.3周.末次随访时髋关节功能采用Merle D'Aubigne评分系统评定:优5例,良2例,可1例.8例患者术后均无血管神经损伤、伤口感染、术中大出血、下肢深静脉血栓形成等并发症发生.结论:微创经皮桥接钢板技术治疗真骨盆缘完整的髋臼前柱骨折具有创伤小、出血少、恢复快、疗效好等优点,是一种治疗髋臼前柱骨折的良好手术方式.%Objective:To discuss feasibility and clinical effects of minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim.Methods:From May 2013 to December 2015,8 patients with acetabulum anterior column fracture with intact true pelvic brim were reviewed retrospectively.According to JudetLetournel classification,all were simple unstable acetabulum anterior column fracture.Among them,there were 5 males and 3 females with an average age of 42.8 years old ranging from 22 to 63.The injury was caused by crush in 4 cases,smash of heavy object in 3 cases,and falling down in 1 case.The time from injury to operation was ranged from 5 to 19 days with an average of 9.5 days.Preoperative CT showed high anterior column fracture of acetabulum with intact true pelvic brim,the fracture separation was less than 1 cm.All the patients were treated with closed reduction and minimally invasive percutaneous plate osteosynthesis.The quality of fracture reduction,operation time,blood loss,fracture healing time,hip function and postoperative complications were observed and recorded.Results:All patients were followed up from 10 to 19 months with an average of 14.5 months.The quality of reduction was classified as anatomical in 4 patients,imperfect in 3,poor in 1 by Matta's score system.The operation time was 30 to 80 min,averaged 51.3 min;the blood loss was 50 to 120 ml,averaged 86.2 ml;fracture healing time was 10 to 19 weeks,averaged 13.3 weeks.At the latest follow-up,the hip function was evaluated by Merle D'Aubigne scoring system,5 cases got excellent results,2 cases in good,and 1 case in fair.No vascular nerve injury,wound infection,bleeding,deep vein thrombosis and other complications occurred in 8 patients.Conclusion:Minimally invasive percutaneous plate osteosynthesis in treating acetabulum anterior column fracture with intact true pelvic brim has advantages of less trauma,less bleeding,quick recovery and good curative effect,and it is a good surgical procedures for acetabulum anterior column fracture.