经不同手术入路治疗髋臼双柱骨折的疗效分析

摘要

Objective To evaluate the treatment effects of patients with both column acetabular fractures through different surgical approaches, and to analyze the principles on approach selections. Methods Fifty-nine patients who had undergone open reduction and internal fixation of both column fractures of the acetabulum between May 1996 and December 2004 were thoroughly followed up. Ilio-inguinal (I-I) approach was used in 38 cases, Kocher-Langenbeck (K-L) approach in 7 cases, combined approach (I-I and K-L) in 12 cases, extended ilio-femoral approach in 1 case, combined K-L and ilio-femoral approach in 1 case. Open reduction and internal fixation with plate and screws were used in all patients. Results Fifty-nine patients were followed up for a mean time of 70.3 (22-101) months. The clinical result was excellent in 25 patients, good in 28, fair in 5 and poor in 1. Overall good and excellent rate was 89. 8% . Complications included avas-cular necrosis of femoral head in 3 patients, heterotopic ossification in 6 and infection in 1. Fifty-nine patients were divided into single approach group and combined or extended approach group. The operative time of each group was 3.59 hours and 5.01 hours (P= 0.000). There was no significant difference in autotransfusion volume (P =0.993) , but there were significant differences in allogeneic transfusion volume (P =0. 028) and clinical results (P = 0. 024). Conclusion Compared with combined or extended approach to treat the patients with both column acetabular fractures, the single approach has shorter operative time, lower transfusion volume and better clinical results.%目的 比较经不同手术入路治疗髋臼双柱骨折患者的疗效,分析髋臼双柱骨折选择手术入路的原则.方法 随访1996年5月～2004年12月手术治疗的髋臼双柱骨折患者59例,均有完整随诊资料.手术入路分布为:髂腹股沟入路38例,Kocher-Langenbeck入路7例,前后联合人路(前两个手术入路的联合使用)12例,扩展的髂股骨入路1例,Kocher-Langenbeck入路联合髂股骨入路1例.全部病例均接受切开复位钢板螺钉固定.结果 59例患者获得平均70.3(22～101)个月的随访.临床功能优25例、良28例、中5例、差1例,优良率为89.8％.股骨头缺血坏死3例、异位骨化6例、感染1例(联合人路).单一手术入路、联合或扩展手术入路患者的平均手术用时分别为3.59 h及5.01 h(P=0.000),术中平均自体血液回输量差异无显著性(P=0.993),平均异体血液输入量差异有显著性(P=0.028),临床功能优良率差异有显著性(P=0.024).结论 经单一手术入路治疗髋臼双柱骨折手术时间短、术中用血量少、临床疗效优于经联合或扩展手术入路治疗.