目的:评价股骨转子翻转截骨术联合Kocher-Langenbeck入路治疗髋臼后壁高位骨折的临床疗效。
方法:对2020年1月至2022年12月20例髋臼后壁高位骨折患者进行回顾性分析,包括12名男性和8名女性,18至75岁。根据手术方式的不同分为两组。10例患者采用大转子截骨联合Kocher-Langenbeck入路作为观察组,包括5名男性和5名女性,年龄从18岁到75岁。10例患者单独采用Kocher-Langenbeck方法作为对照组,包括7名男性和3名女性,年龄从18岁到71岁。采用Matta减量标准评价两组的减量质量,并采用Harris评分比较两组患者最新随访时的髋关节功能。操作时间,分析两组患者术中出血量及术后并发症发生情况。
结果:所有患者均获10~24个月随访。根据Matta骨折复位质量评价标准,观察组解剖复位6例,令人满意的减少了3例,1例减少不满意,而对照组仅实现解剖复位3例,令人满意的减少了3例,4例减少不满意。在最后的后续行动中,观察组Harris髋关节评分为71.4~96.6分,对照组为65.3~94.5分。根据Harris评分结果。观察组髋关节功能优6例,在3种情况下很好,在一个案例中公平。对照组髋关节功能优2例,在3种情况下很好,在3个案例中公平,差2例。在观察组中,术中失血量300~700ml,手术时间为120~180min;对照组,术中出血量300~650ml,手术时间为100~180min。观察组并发症包括创伤性关节炎1例,异位骨化1例,而对照组的并发症包括3例创伤性关节炎,异位骨化3例,髋关节外展无力1例。
结论:转子翻转截骨术联合Kocher-Langenbeck入路可显著提高骨折的解剖复位率,增强优秀和良好的髋关节功能结果,与单纯Kocher-Langenbeck入路相比,手术并发症发生率降低。这种联合方法的临床应用前景广阔,尽管需要更大的研究进行进一步验证。
OBJECTIVE: Evaluation of the clinical efficacy of f trochanteric flip osteotomy combined with Kocher-Langenbeck approach for high acetabular posterior wall fracture.
METHODS: Between January 2020 and December 2022, 20 patients with high acetabular posterior wall fractures were retrospectively analyzed, including 12 males and 8 females, aged 18 to 75 years old. They were divided into two groups according to the different surgical methods. Ten patients were treated with greater trochanteric osteotomy combined with Kocher-Langenbeck approach as the observation group, including 5 males and 5 females, aged from 18 to 75 years old. Ten patients were treated with Kocher-Langenbeck approach alone as the control group, including 7 males and 3 females, aged from 18 to 71 years old. Matta reduction criteria were used to evaluate the reduction quality of the two groups, and Harris score was used to compare the hip function of the two groups at the latest follow-up. The operation time, blood loss and postoperative complications of the two groups were analyzed.
RESULTS: All patients were followed up for 10 to 24 months. According to the Matta fracture reduction quality evaluation criteria, the observation group achieved anatomical reduction in 6 cases, satisfactory reduction in 3 cases, and unsatisfactory reduction in 1 case, while the control group only achieved anatomical reduction in 3 cases, satisfactory reduction in 3 cases, and unsatisfactory reduction in 4 cases. At the final follow-up, the Harris hip score ranged from 71.4 to 96.6 in the observation group and 65.3 to 94.5 in the control group. According to the results of Harris score. The hip joint function of the observation group was excellent in 6 cases, good in 3 cases, and fair in 1 case. The hip joint function of the control group was excellent in 2 cases, good in 3 cases, fair in 3 cases, and poor in 2 cases. In the observation group, the intraoperative blood loss ranged from 300 to 700 ml, and the operation duration ranged from 120 to 180 min;in the control group, the intraoperative blood loss ranged from 300 to 650 ml, and the operation duration ranged from 100 to 180 min. Complications in the observation group included 1 case of traumatic arthritis and 1 case of heterotopic ossification, while complications in the control group included 3 cases of traumatic arthritis, 3 cases of heterotopic ossification and 1 case of hip abduction weakness.
CONCLUSIONS: Trochanteric flip osteotomy combined with the Kocher-Langenbeck approach significantly improved anatomical fracture reduction rates, enhanced excellent and good hip joint function outcomes, and reduced surgical complication incidence compared to the Kocher-Langenbeck approach alone. Clinical application of this combined approach is promising, although larger studies are needed for further validation.