目的:比较大粗隆入路与标准Kocher-Langenbeck(K-L)入路治疗髋臼后壁骨折的临床疗效,探讨治疗髋臼后壁骨折的最佳入路。
方法:对26例髋臼后壁骨折患者进行回顾性分析,分为两组:大粗隆组(试验组)和标准K-L入路组(对照组)。在测试组中,其中男16例,女8例,平均年龄(42.00±4.52)岁,损伤至手术时间为(6.75±1.15)d。对照组其中男16例,女7例,平均年龄(41.00±5.82)岁,手术时间为(7.09±1.20)天。总住院时间,切口长度,操作时间,术中出血,术后引流,放电,骨折复位质量(马塔标准),髋部外展肌肉力量,髋关节功能(Merled\'Aubigne-Postel评分),比较术后并发症和异位骨化的发生率。
结果:全部病例随访6个月。切口长度无显著差异,术中出血、术后引流量比较差异无统计学意义(P>0.05)。然而,试验组手术时间短于对照组(P<0.05)。两组患者骨折复位、髋关节功能差异无统计学意义(P>0.05)。试验组髋关节外展肌力优于对照组(P<0.05)。此外,两组术后并发症及异位骨化发生率比较差异无统计学意义(P>0.05)。
结论:与标准K-L方法相比,大转子后路半盆切除术可缩短手术时间,术后髋关节外展肌力恢复较好,暴露了涉及更粉碎性髋臼后壁或窝顶骨折的骨折的视图,提高骨折解剖复位率,为髋臼后壁骨折的临床治疗提供了新的思路,并允许患者在早期进行功能锻炼。
OBJECTIVE: To compare the clinical efficacy of the posterior
hemipelvectomy of the greater trochanter approach with the standard Kocher-Langenbeck(K-L) approach in the treatment of posterior acetabulum wall fractures and to explore a more optimal approach for the treatment of posterior acetabulum wall fractures.
METHODS: Total of 26 patients with posterior acetabulum wall fractures were retrospectively analysed and divided into two groups:the posterior
hemipelvectomy of the greater trochanter group (test group) and the standard K-L approach group (control group). In the test group, there were 24 patients including 16 males and 8 females with an average age of (42.00±4.52) years old, the time of injury to surgery was (6.75±1.15) d. In the control group, there were 23 patients including 16 males and 7 females with an average age of (41.00±5.82) years old, the time of injury to surgery was (7.09±1.20) days. The total hospital stay, length of incision, operation time, intraoperative bleeding, postoperative drainage, discharge, fracture reduction quality (Matta criteria), hip abduction muscle strength, hip function (Merle d\'Aubigne-Postel score), postoperative complications and the incidence of ectopic ossification were compared.
RESULTS: All cases were followed up for 6 months. There was no significant difference in incision length, intraoperative bleeding and postoperative drainage between two groups(P>0.05). However, the operation time of the test group was shorter than that of the control group (P<0.05). There was no statistically significant difference in fracture reduction and hip function between two groups (P>0.05). The hip abduction muscle strength of test group was better than that of control group(P<0.05). In addition, there was no significant difference in the incidence of postoperative complications and heterotopic ossification between two groups(P>0.05).
CONCLUSIONS: Compared with the standard K-L approach, the posterior
hemipelvectomy of the greater trochanter approach can shorten the operative time, has better recovery of the postoperative hip abduction muscle strength, exposes the view of the fracture involving the more comminuted posterior acetabulum wall or the fracture of the roof of the socket, improved the rate of fracture anatomical repositioning, provides a new idea for the clinical treatment of posterior acetabulum wall fractures, and allows patients to perform functional exercises at an early stage.