采用单一改良K-L入路同时治疗髋臼双柱骨折.docVIP

采用单一改良K-L入路同时治疗髋臼双柱骨折【摘要】 目的 回顾性分析髋臼双柱骨折患者，探讨采用单一改良K-L入路同时治疗髋臼双柱骨折方法。方法 对12例髋臼骨折的患者采用单一改良K-L入路同时治疗髋臼双柱骨折，术后功能锻炼。结果 随访6～27个月，按Matta标准评价髋臼复位质量：解剖复位7例，满意复位3例，不满意复位2例，优良率83．3％。髋关节功能参照改良的Merle d，Aubigne标准：优6例，良3例，可1例，差2例，优良率75％。结论 充分的术前计划、恰当的手术时机、充分的术野暴露以及良好的术后锻炼是治疗髋臼骨折的有效方法。 【关键词】髋臼骨折；内固定；手术入路 Surgical treatment anterior and posterior acetabular column fractures with single modified Kocher-Langenbeck（K-L） approach ZHU Bao-lin,WANG Hong-jun,WU Yong.Department of Orthopeadics,Shuyang Peoples Hospital,Jiangsu Shuyang 223600,China 【Abstract】 Objective To summarize retrospectively the clinical therapeutic and to investigate the treatment method of anterior and posterior acetabular column fractures with single modified Kocher-Langenbeck（K-L） approach.Methods From2000,12 patients with anterior and posterio acetabular column fractures were treated by single modified Kocher-Langenbeck（K-L） approach and functional exercise after operation.Results All patients were followed up ranged from 6-27 months.According to Matta’s radiographic assessment system,the curative effect was anatomical in 7 patients,imperfect in 3 and poor in 2,the excellent and good rate was 83．3%.The functional outcome was measured by the modified Merle d，Aubigne score were:excellent in 6,good in 3,fair in 1 and poor in 2,the excellent and good rate was 75%.Conclusion Abundance operation plan,correct operation time,correct operative approach and functional exercise can improve therapeutic effects in serious acetabular fractures. 【Key words】Acetabular fracture;Internal fixation;Operative approach 髋臼骨折是高能量损伤性骨折，其中最为复杂的是双柱骨折。这种骨折以往需要采用前后联合入路才能取得较好治疗效果。我们回顾分析自2000年以来我院采用单一改良K-L入路同时治疗髋臼前后柱骨折患者12例，现将结果报 告如下。 1 资料与方法 1．1 一般资料 12例中，男7例，女5例，年龄24～57岁，平均33岁。受伤原因及分型交通事故9例，高处坠落3例。左侧10例、右侧2例，骨折移位5～35 mm。12例中分别合并有失血性休克、颅脑损伤、软组织挫裂伤、脾破裂、脂肪栓塞、坐骨神经损伤、股骨头中心脱位、后脱位、胫骨骨折等多种合并伤。手术时间：12例中,4例3～6 d手术，7例7～10 d手术，1例14 d手术。 1．2 治疗方法 1．2．1 术前准备 12例患者术前给予胫骨或股骨牵引，期间同时治疗合并伤，并完成其他术前准备。所有患者均行骨盆正位、患髋正位X线检查；闭孔和髂骨斜位因在