Braun W, Mayr E, Rüter A
Klinik für Unfall- und Weiederherstellungschirurgie, Zentralklinik Augsburg, D-86156, Augsburg.
Oper Orthop Traumatol. 1997 Jun;9(2):83-96. doi: 10.1007/s00064-006-0014-8.
Approach to the essential bony parts of the pelvis which can be adapted to the fracture pattern and which causes minimal soft tissue damage. It allows exposure of the posterior and anterior columns and the roof of the acetabulum.
Complex acetabular fractures such as 2-column fractures, T-fractures, displaced transverse fractures with posterior rim fragment, fractures of 1 column.
Fractures which can be approached through smaller incisions, preexisting lesions of the superior gluteal artery, arterial occlusive diseases, particularly of the pelvis.
Radiographs of the pelvis in anterior-posterior and two oblique news. Special radiographs and CT.
Lateral decubitus with free draping of the leg. Endotracheal anaesthesia. Cell saver optional.
T-shaped skin incision and gradual extension of the Kocher-Langenbeck approach depending on the fracture pattern. First extensile step: Transverse division of the fascia lata and osteotomy of the greater trochanter. Second extensile step: Osteotomy of part of the iliac crest and exposure of the outer and inner cortex of the iliac wing.
Operated leg rests in a foam padded splint. Careful wound drainage, routine low dose radiation or indomethacin to prevent heterotopic ossification. CPM starting the 2nd postoperative day, mobilization starting the 2nd or 3rd day with partial weight bearing of 15 kg. Full weight bearing depends on fracture type and consolidation.
Delayed wound healing with risk of infection. Injury to the superior gluteal artery with danger of necrosis of the abductor muscles. Injury through stretching of the sciatic nerve. Injury of the lateral femorocutaneous nerve.
Seven patients with complex acetabular fractures were operated between June 1993 and January 1994. Use of the 1st extensile step was sufficient in 3 patients and 3 times all 4 steps were used. Postoperative necrosis of fatty tissue necessitated 2 revisions. All fractures consolidated. During the follow-up examination 1 case of heterotopic ossification was seen (Brooker grade II). Using the classification of Merle D'Aubigné we had 1 excellent, very good, 2 good and 1 satisfactory result.
接近骨盆的主要骨性部分，该方法可根据骨折类型进行调整，并使软组织损伤最小。它可显露髋臼的前后柱及髋臼顶。
复杂髋臼骨折，如双柱骨折、T形骨折、伴有后缘骨折块的移位横形骨折、单柱骨折。
可通过较小切口处理的骨折、臀上动脉的既往病变、动脉闭塞性疾病，尤其是骨盆的此类疾病。
骨盆前后位及两个斜位X线片。特殊X线片及CT检查。
侧卧位，腿部自由铺巾。气管内麻醉。可选用血液回收装置。
根据骨折类型做T形皮肤切口并逐步扩大Kocher-Langenbeck入路。第一步扩大：横向切开阔筋膜并做大转子截骨。第二步扩大：部分髂嵴截骨并显露髂骨翼的内外侧皮质。
术侧下肢置于泡沫衬垫夹板中。仔细伤口引流，常规低剂量放疗或使用吲哚美辛以预防异位骨化。术后第2天开始使用持续被动活动装置（CPM），术后第2或3天开始活动，部分负重15kg。完全负重取决于骨折类型及愈合情况。
伤口愈合延迟并有感染风险。臀上动脉损伤并有外展肌坏死风险。坐骨神经牵拉伤。股外侧皮神经损伤。
1993年6月至1994年1月间对7例复杂髋臼骨折患者进行了手术。3例患者仅需第一步扩大，3例患者4步均使用。术后脂肪组织坏死需2次翻修。所有骨折均愈合。随访检查中发现1例异位骨化（布鲁克二级）。根据Merle D'Aubigné分类，结果为1例优、1例良、2例尚可、1例满意。
