经联合的髂腹股沟和K-L入路治疗累及前后柱的髋臼骨折

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1、·8·临床骨科杂志JournalofClinicalOrthopaedics2010Feb；13(1)·临床论著·经联合的髂腹股沟和K—L入路治疗累及前后柱的髋臼骨折安智全，谢孝兴，姜朝来，曾炳芳摘要：目的探讨累及前、后柱的髋臼骨折的治疗方法。方法采用前侧髂腹股沟联合后侧的K—L入路切开复位，重建带或重建钢板内固定治疗25例累及前、后柱的髋臼骨折。记录手术时间、术中出血量、输血量，用Matta标准评价骨折复位程度。采用改良Harris髋关节评分标准和dAubigne—Postel标准评价髋关节功能。结果手术时间18

2、O一495(322．6±85．4)min，术中出血量400～5000(1402．0±908．4)ml，输血400～4000(1104．0±663．0)ml。其中9例采用自体血回输，输血量119—750(322．3±206．8)ml。根据Matta骨折复位标准：完全解剖复位23例，满意复位2例。24例得到12～61(32±15．8)个月随访。骨折均获得骨性愈合。BrookerIU型异位骨化和股骨头坏死各2例。改良Harris评分74～120(112．5±15．1)分。根据dAubigne—Postel标准：优l6例，

3、良4例，可3例，差1例。结论采用经髂腹股沟和髋关节后侧联合入路切开复位内固定治疗累及前后柱的髋臼骨折可获得良好效果。关键词：髋臼骨折；髂腹股沟人路；Kocher—Lengenbeck入路；骨折固定术中图分类号：R683．3；R687．32文献标识码：A文章编号：1008—0287(2010】01—0008—04Surgicaltreatmentoftheacetabularfracturesinvolvingbothanteriorandposteriorcolumnsthroughacombinedilioing

4、uinalandKocher-LengenbeckapproachANZhi-quan．XIEXiao-xing，JIANGChao一，ZENGBing扣(DeptofOrthopaedicSurgery，ShanghaiSixthPeoplesHospital，ShanghaifiaotongUniversity，Shanghai200233，China)Abstract：ObjeetiveToexplorethesurgicaltreatmentoftheacetabularfracturesinvolving

5、anteriorandposteriorcolumns．Methods25casesoftheacetabularfracturesinvolvingboththeanteriorandposteriorcolumnsweresurgi—callytreatedwithopenreductionandinternalfixationwithreconstructionplateorreconstructionribbonsthroughacombinedilioinguinalandKocher—Lengenbec

6、kapproach．Theoperatingtime．thevolumeofintra—operativebloodlossandbloodtransfusionswererecorded．ThereductionwasradiologicallyevaluatedbasedonthecriteriadescribedbyMatta．Atthefinalfollow-up，thepatientswereevaluatedclinicallyaccordingtotheModifiedHarrishipscorean

7、ddAubigne—Postelscoringsystem．ResultsThemeanoperatingtimeof25caseswas322．6±85．4(180～495)mi—nuteswithamcanvolumeof1402．0±908．4(40O～5000)mlintraoperativebloodloss．Themeanvolumeofintra—operativebloodtransfusionwas1104．0±663．0(400～4000)m1．Autologousbloodreinfusion

8、wasappliedin9ca—seswithameanvolumeof322．3±206．8(119～750)m1．Perfectandimperfectreductionswereidentifiedin23ca—sesand2cases．respectively，withoutpoorreductions．24caseswerefollowedupwi