Märdian S, Schaser K D, Hinz P, Wittenberg S, Haas N P, Schwabe P
Charité - university medicine Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
Bone Joint J. 2015 Sep;97-B(9):1271-8. doi: 10.1302/0301-620X.97B9.35403.
This study compared the quality of reduction and complication rate when using a standard ilioinguinal approach and the new pararectus approach when treating acetabular fractures surgically. All acetabular fractures that underwent fixation using either approach between February 2005 and September 2014 were retrospectively reviewed and the demographics of the patients, the surgical details and complications were recorded. A total of 100 patients (69 men, 31 women; mean age 57 years, 18 to 93) who were consecutively treated were included for analysis. The quality of reduction was assessed using standardised measurement of the gaps and steps in the articular surface on pre- and post-operative CT-scans. There were no significant differences in the demographics of the patients, the surgical details or the complications between the two approaches. A significantly better reduction of the gap, however, was achieved with the pararectus approach (axial: p = 0.025, coronal: p = 0.013, sagittal: p = 0.001). These data suggest that the pararectus approach is at least equal to, or in the case of reduction of the articular gap, superior to the ilioinguinal approach. This approach allows direct buttressing of the dome of the acetabulum and the quadrilateral plate, which is particularly favourable in geriatric fracture patterns.
本研究比较了采用标准髂腹股沟入路和新的腹直肌旁入路手术治疗髋臼骨折时的复位质量和并发症发生率。对2005年2月至2014年9月期间采用这两种入路之一进行固定的所有髋臼骨折患者进行回顾性研究，记录患者的人口统计学资料、手术细节及并发症情况。共纳入100例连续接受治疗的患者（男69例，女31例；平均年龄57岁，18至93岁）进行分析。通过术前和术后CT扫描对关节面间隙和台阶进行标准化测量来评估复位质量。两种入路在患者人口统计学资料、手术细节或并发症方面均无显著差异。然而，腹直肌旁入路在间隙复位方面明显更好（轴向：p = 0.025，冠状面：p = 0.013，矢状面：p = 0.001）。这些数据表明，腹直肌旁入路至少与髂腹股沟入路相当，或者在关节间隙复位方面优于髂腹股沟入路。该入路可直接支撑髋臼顶和四边形板，这在老年骨折类型中尤为有利。
