CAJ | 학술논문

目的探讨经腹直肌外侧小切口入路辅助经皮后柱顺行拉力螺钉固定技术治疗髋臼前、后柱骨折的手术技巧及临床疗效. 方法回顾性分析2013年1月至2014年6月采用经腹直肌外侧小切口入路辅助经皮后柱顺行拉力螺钉固定技术治疗的11例髋臼前、后柱骨折患者资料,男7例,女4例;年龄为31 ～ 50岁,平均43.2岁;骨折按Letournel-Judet分型:前柱伴后半横形骨折8例,双柱骨折3例.患者取平卧位,经前方腹直肌外侧小切口入路,先直视下对髋臼前柱骨折进行复位,将预弯的钢板放置于髋臼内侧面固定前柱;牵拉、撬拨复位后柱骨折后,经皮沿小骨盆环上缘向坐骨棘或坐骨结节方向打入直径为6.5 mm的空心螺钉导针,再沿导针置入顺行拉力螺钉固定后柱. 结果本组11例患者手术切口长度为6～8 cm,平均7.0 cm;手术时间为45～115 min,平均65.1 min;术中出血量为150 ～ 550 mL,平均400.3 mL.术后按Matta影像学评分标准评定骨折复位质量:优7例,良3例,差1例.11例患者术后获6～12个月(平均10个月)随访.骨折愈合时间为6～ 10周(平均8周).术后6个月根据改良Merle d'Aubigné和Postel评分系统评定临床疗效:优6例,良4例,可1例.1例患者术后3个月出现髋臼后壁异位骨化.随访期间无一例患者发生腹股沟疝、切口疝等并发症. 结论经腹直肌外侧小切口入路辅助经皮后柱顺行拉力螺钉固定技术能直视下复位并有效固定髋臼前、后柱骨折,疗效良好.
목적 탐토경복직기외측소절구입로보조경피후주순행랍력라정고정기술치료관구전、후주골절적수술기교급림상료효. 방법 회고성분석2013년1월지2014년6월채용경복직기외측소절구입로보조경피후주순행랍력라정고정기술치료적11례관구전、후주골절환자자료,남7례,녀4례;년령위31 ～ 50세,평균43.2세;골절안Letournel-Judet분형:전주반후반횡형골절8례,쌍주골절3례.환자취평와위,경전방복직기외측소절구입로,선직시하대관구전주골절진행복위,장예만적강판방치우관구내측면고정전주;견랍、효발복위후주골절후,경피연소골분배상연향좌골극혹좌골결절방향타입직경위6.5 mm적공심라정도침,재연도침치입순행랍력라정고정후주. 결과 본조11례환자수술절구장도위6～8 cm,평균7.0 cm;수술시간위45～115 min,평균65.1 min;술중출혈량위150 ～ 550 mL,평균400.3 mL.술후안Matta영상학평분표준평정골절복위질량:우7례,량3례,차1례.11례환자술후획6～12개월(평균10개월)수방.골절유합시간위6～ 10주(평균8주).술후6개월근거개량Merle d'Aubigné화Postel평분계통평정림상료효:우6례,량4례,가1례.1례환자술후3개월출현관구후벽이위골화.수방기간무일례환자발생복고구산、절구산등병발증. 결론 경복직기외측소절구입로보조경피후주순행랍력라정고정기술능직시하복위병유효고정관구전、후주골절,료효량호.
Objective To evaluate reduction and fixation of displaced acetabular fractures of both anterior and posterior columns using a small incision via lateral-rectus approach and percutaneous fixation.Methods From January 2013 to June 2014,11 patients with displaced acetabular fracture of both columns were surgically managed through the minimally invasive lateral-rectus approach and percutaneous fixation.They were 7 males and 4 females,with an average age of 43.2 years (from 31 to 50 years).According to Letournel-Judet classification,there were 8 anterior + posterior hemitransverse fractures and 3 both-column fractures.All fractures were treated via the lateral-rectus approach in a horizontal position after general anesthesia.The plate bended in advance was placed in the interior pelvic ring to fix the anterior column under direct vision.The ischial spine along the interior quadrilateral surface was exposed to reduce posterior column fractures.Then,the posterior column was fixed percutaneously by antegrade lag screws (6.5 mm) after a hook-wire was implanted in the posterior column along the ischial spine or ischial tuberosity.Results The operative incisions ranged from 6 to 8 cm (average,7.0 cm);the operation time ranged from 45 to 115 min (average,65.1 min);the intraoperative bleeding ranged from 150 to 550 mL (average,400.3 mL).According to the Matta radiological evaluation,reduction of acetabular fractures was rated as excellent in 7 cases,good in 3 and fair in one.All patients were followed up for 6 to 12 months (average,10 months).Their fractures united after 6 to 10 weeks (average,8 weeks).According to the modified Merle d'Aubigné and Postel scoring system,6 cases were excellent,4 good,and one fair at 6 months after operation.Ectopic ossification was observed at the posterior wall at 3 months after operation in one patient.No inguinal hernia or incisional hernia was observed in the follow-ups.Conclusions A small incision via the lateral-rectus approach and percutaneous fixation for displaced acetabular fractures of anterior and posterior columns may lead to good reduction and functional outcomes with no complications,because the anterior approach offers visibility and feasibility in treating displacements of both columns.