[1]王瑞雄,吴天然,叶志强,等.腹直肌外侧入路结合翼状接骨板治疗髋臼骨折21例疗效分析[J].中国中医骨伤科杂志,2023,31(12):59-63.[doi:10.20085/j.cnki.issn1005-0205.231212]
　WANG Ruixiong,WU Tianran,YE Zhiqiang,et al.21 Cases Analysis of Curative Effect of Lateral Rectus Abdominis Approach Combined with Pterygoid Plate in the Treatment of Acetabular Fractures[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2023,31(12):59-63.[doi:10.20085/j.cnki.issn1005-0205.231212]
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腹直肌外侧入路结合翼状接骨板治疗髋臼骨折21例疗效分析()
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《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第31卷
期数:
2023年12期
页码:
59-63
栏目:
临床报道
出版日期:
2023-12-15

文章信息/Info

Title:
21 Cases Analysis of Curative Effect of Lateral Rectus Abdominis Approach Combined with Pterygoid Plate in the Treatment of Acetabular Fractures
文章编号:
1005-0205(2023)12-0059-05
作者:
王瑞雄1; 吴天然1; 叶志强1; 敖庆芳1; 陈夏平1
1泉州市正骨医院(福建 泉州,362000)
Author(s):
WANG Ruixiong1; WU Tianran1; YE Zhiqiang1; AO Qingfang1; CHEN Xiaping1
1Quanzhou Orthopedic-Traumatological Hospital,Quanzhou 362000,Fujian China.
关键词:
腹直肌外侧入路;  腹直肌旁入路;  髋臼骨折;  翼状接骨板
Keywords:
lateral rectus abdominis approach;  para-rectus abdominis approach;  acetabular fracture;  pterygoid plate
分类号:
R683.42
DOI:
10.20085/j.cnki.issn1005-0205.231212
文献标志码:
B
摘要:
目的:探讨应用腹直肌外侧入路结合翼状接骨板治疗髋臼骨折的临床疗效和安全性。方法:回顾性分析2021年5月至2023年3月采用腹直肌外侧入路治疗的21例髋臼骨折患者,男16例,女5例; 平均年龄为46岁(29～62岁)。按Letournel-Judet分型:前柱骨折8例,前柱合并后半横行骨折5例,横行骨折4例,T形骨折4例。交通事故伤7 例,高处坠落伤8例,跌伤6例。3例合并桡骨远端骨折,5例合并多发肋骨骨折和肺挫伤,2例合并肾挫伤。均采用腹直肌外侧入路结合翼状接骨板固定治疗,术后采用Matta标准评价骨折复位质量,同时记录治疗及随访期间的并发症情况。结果:21例获得3～21个月随访,平均为8个月。根据Matta标准:解剖复位18例,满意复位3例。根据Merle d'Aubigne-Postel髋关节功能评分:优16例,良4例,可1例。结论:腹直肌外侧入路结合翼状接骨板治疗髋臼骨折操作安全,出血少,术野清晰,骨折复位和固定相对容易,术后并发症少,值得临床推荐。
Abstract:
Objective:To investigate the clinical efficacy and safety of the lateral rectus abdominis approach combined with pterygoid plate in the treatment of acetabular fractures.Methods:21 cases of acetabular fractures were treated and retrospectively analyzed with the lateral rectus abdominis approach,including 16 males and 5 females,with an average age of 46 years old(2962 years old)from May 2021 to March 2023.According to the Letournel-Judet classification,there were 8 cases of anterior column fracture,5 cases of anterior column combined posterior semitransverse fracture,4 cases of transverse fracture,and 4 cases of T-shaped fracture.There were 7 cases of traffic accident injuries,8 cases of falls from heights,and 6 cases of fall injuries.There were 3 cases with distal radius fracture,5 cases with multiple rib fractures and lung contusion,and 2 cases with renal contusion.All patients were treated by lateral rectus abdominis approach combined with pterygoid plate fixation.The quality of fracture reduction was evaluated by Matta standard after operation,and the complications during treatment and follow-up were recorded.Results:21 cases were followed up for 3 to 21 months,with an average of 8 months.According to the Matta standard,18 cases were anatomically reduced while 3 cases were satisfactorily reduced.According to the Merle d'Aubigne-Postel hip function score,16 cases were excellent,4 cases were good,and 1 case was fair.Conclusion:The lateral rectus abdominis approach combined with pterygoid plate in the treatment of acetabular fractures has the characteristics of safe operation,less bleeding,clear operative field,relatively easy fracture reduction and fixation and fewer postoperative complications,is clinically recommended.

参考文献/References:

[1] JUDET R,JUDET J,LETOURNEL E.Surgical treatment of recent fractures of the acetabulum(apropos of 46 operated cases)[J].Mem Acad Chir(Paris),1962,88:369-377.
[2] 倪明,沈燕国,胡晓亮,等.经改良Stoppa入路治疗骨盆髋臼骨折的临床体会[J].中国骨与关节损伤杂志,2013,28(2):101-103.
[3] BERBEROGLU M,UZ A,OZMEN M M,et al.Corona mortis:an anatomic study in seven cadavers and an endoscopic study in 28 patients[J].Surg Endosc,2001,15(1):72-75.
[4] MATTA J M.Fractures of the acetabulum:accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury[J].Journal of Bone and Joint Surgery,1996,78(11):1632-1645.
[5] RICKMAN M,VARGHESE V D.Contemporary acetabular fracture surgery:treading water or swimming upstream?[J].Bone Joint J,2017,99-B(9):1125-1131.
[6] KELLY J,LADURNER A,RICKMAN M.Surgical management of acetabular fractures:a contemporary literature review[J].Injury,2020,51(10):2267-2277.
[7] 刘潇,李明,刘建恒,等.不同手术入路治疗髋臼双柱骨折的研究进展[J].中国修复重建外科杂志,2021,35(6):661-666.
[8] MEENA S,SHARMA P K,MITTAL S,et al.Modified Stoppa approach versus Ilioinguinal approach for anterior acetabular fractures:a systematic review and meta-analysis[J].Bull Emerg Trauma,2017,5(1):6-12.
[9] BOUDISSA M,FRANCONY F,KERSCHBAUMER G,et al.Epidemiology and treatment of acetabular fractures in a level-1 trauma centre:retrospective study of 414 patients over 10 years[J].Orthop Traumatol Surg Res,2017,103(3):335-339.
[10] BASTIAN J D,SAVIC M,CULLMANN J L,et al.Surgical exposures and options for instrumentation in acetabular fracture fixation:pararectus approach versus the modified Stoppa[J].Injury,2016,47(3):695-701.
[11] SRIVASTAVA A,RAJNISH R K,KUMAR P,et al.Ilioinguinal versus modified Stoppa approach for open reduction and internal fixation of displaced acetabular fractures:a systematic review and meta-analysis of 717 patients across ten studies[J].Arch Orthop Traum Surg,2022,143(2):895-907.
[12] 王瑞雄,陈夏平,刘志强,等.改良Stoppa入路在髋臼及骨盆骨折手术治疗中的应用[J].中国骨与关节损伤杂志,2014,29(2):108-110.
[13] SHIGEMURA T,MURATA Y,YAMAMOTO Y,et al.Comparison between Ilioinguinal approach and modified Stoppa approach for the treatment of acetabular fractures:an updated systematic review and meta-analysis[J].Orthop Traumatol Surg Res,2022,108(2):103204.
[14] 张潇,杨晓东,夏广,等.经腹直肌外侧切口入路重建钢板辅助后柱顺行拉力螺钉治疗复杂髋臼骨折[J].创伤外科杂志,2015,17(2):123-126.
[15] KEEL M J B,ECKER T M,CULLMANN J L,et al.The pararectus approach for anterior intrapelvic management of acetabular fractures:an anatomical study and clinical evaluation[J].J Bone Joint Surg Br,2012,94(3):405-411.
[16] 杨晓东,刘涵,谷城,等.髂坐钢板经腹直肌外侧入路治疗涉及方形区的髋臼骨折[J].中国矫形外科杂志,2019,27(20):1836-1840.
[17] 张彬,李涛,麦奇光,等.经腹直肌外侧入路钢板结合后柱拉力螺钉内固定治疗髋臼前后柱骨折[J].中国骨与关节损伤杂志,2017,32(4):337-340.
[18] TANNAST M,KEEL M J B,SIEBENROCK K A,et al.Open reduction and internal fixation of acetabular fractures using the modified Stoppa approach[J].JBJS Essent Surg Tech,2019,9(1):e3.
[19] KEEL M J B,SIEBENROCK K A,TANNAST M,et al.The pararectus approach:a new concept[J].JBJS Essent Surg Tech,2018,8(3):e21.
[20] WENZEL L.The pararectus approach in acetabular surgery:radiological and clinical outcome[J].J Orthop Trauma,2020,34(2):82-88.
[21] CHUI K H,CHAN C C D,IP K C,et al.Three-dimensional navigation-guided percutaneous screw fixation for nondisplaced and displaced pelvi-acetabular fractures in a major trauma centre[J].Int Orthop,2018,42(6):1387-1395.
[22] BRAND A,VON RÜDEN C,PROBST C,et al.Early biomechanical outcome in patients with acetabular fractures treated using the pararectus approach:a gait and stair climb analysis study[J].Eur J Trauma Emerg Surg,2021,48(2):1307-1316.
[23] 朱新红,闵继康,张强华,等.经腹直肌外侧切口入路联合跟骨异形钢板内固定治疗累及四边体的髋臼骨折[J].中国骨伤,2022,35(11):1031-1036.
[24] KWAK D K,JANG J E,KIM W H,et al.Is an anatomical suprapectineal quadrilateral surface plate superior to previous fixation methods for anterior column-posterior hemitransverse acetabular fractures typical in the elderly?A biomechanical study[J].Clin Orthop Surg,2022,15(2):182-191.
[25] CHA Y,YOO J I,KIM J T,et al.How to solve anatomical mismatch in fixation of acetabular fractures using an anatomical quadrilateral surface plate?[J].Clin Orthop Surg,2022,15(2):338-342.

更新日期/Last Update: 2023-12-10