Reinert C M, Bosse M J, Poka A, Schacherer T, Brumback R J, Burgess A R
Department of Orthopedic Surgery, United States Naval Hospital, Portsmouth, Virginia 23708.
J Bone Joint Surg Am. 1988 Mar;70(3):329-37.
A modification of the extended iliofemoral incision of Letournel and Judet facilitates the operative exposure of T-type, complex transverse, and both-column acetabular fractures and malunions. The modification includes the utilization of a T-shaped skin incision with large flaps, and osteotomies of the iliac crest, greater trochanter, and anterior superior iliac spine. The iliotibial band is transected and the abductor muscle mass is rotated posteriorly, hinged on the superior gluteal neurovascular bundle. Twenty patients had open reduction and internal fixation of a complex acetabular fracture using this surgical approach. Excellent surgical exposure allowed good or excellent reduction of the acetabulum in all patients. No flap necrosis developed, and all fractures healed. One non-union of a trochanteric osteotomy needed revision. This approach provides increased exposure of the posterior column and visualization of the entire surface of the joint and it allows fixation of the fracture from both sides of the iliac wing. The T-shaped skin incision allows utilization of a standard posterior approach with conversion to the extensile exposure if necessary. Options for late reconstruction are not compromised. Lagscrew fixation of the osteotomies allows aggressive rehabilitation of the joint.
对Letournel和Judet的扩大髂股切口进行改良，有助于T型、复杂横行和双柱髋臼骨折及畸形愈合的手术显露。改良包括采用带大皮瓣的T形皮肤切口，以及髂嵴、大转子和髂前上棘截骨术。切断髂胫束，将外展肌块以臀上神经血管束为铰链向后旋转。20例患者采用该手术方法对复杂髋臼骨折进行切开复位内固定。良好的手术显露使所有患者的髋臼均获得良好或极佳复位。未发生皮瓣坏死，所有骨折均愈合。1例转子截骨不愈合需要翻修。该方法增加了后柱的显露，可直视关节全表面，且能从髂骨翼两侧固定骨折。T形皮肤切口允许采用标准后路入路，必要时可转为扩大显露。不影响后期重建的选择。截骨处的拉力螺钉固定允许积极的关节康复治疗。
