经外侧直肌入路行髋臼周截骨术治疗延迟性髋臼骨折。

Treatment of Delayed Acetabular Fractures by Periacetabular Osteotomy through the Lateral-Rectus Approach.

机构信息

Department of Traumatic Surgery, Center for Orthopaedic Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.

Department of Orthopaedic, Huadu District People's Hospital of Guangzhou, Guangzhou, China.

出版信息

Orthop Surg. 2022 Dec;14(12):3233-3241. doi: 10.1111/os.13509. Epub 2022 Oct 19.

DOI:10.1111/os.13509

PMID:36259635

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9732581/

Abstract

OBJECTIVE

There has been a controversy in the surgical approach for delayed acetabular fracture. The objective of the present study is to investigate the feasibility, surgical techniques, safety, and efficacy of periacetabular osteotomy using the single lateral-rectus approach (LRA) for the surgical treatment of delayed acetabular fracture.

METHODS

The retrospective study included 22 patients (16 males and six females, with an average age of 45 years) with delayed acetabular fractures from June 2012 to June 2019. For all cases, periacetabular osteotomy was performed through the single LRA. Fracture classification, mechanism of injury, associated injury, time to surgery, operation time, intraoperative blood loss, and complications were recorded and analyzed. The quality of the reduction was assessed based on Matta radiographic criteria. Potential impact factors affecting the quality of reduction were analyzed. Functional outcome was evaluated at the final follow-up according to a modified Mere D'Aubigne-Postel scoring system for each patient.

RESULTS

All patients were followed up for at least 12 months. The duration of surgery was 140 min on average (110-205 min) and the mean intraoperative blood loss was 1250 ml (500-2100 ml). According to Matta radiographic criteria, the accuracy of reduction was "anatomical" in seven patients, "imperfect" in 11 patients, and "poor" in four patients, with an excellent and good rate of 81.8%. The time to surgery in poor reduction group was significantly longer than anatomical or imperfect reduction group (p < 0.05). All the acetabular fractures united after 8-12 weeks. The average modified Merle D'Aubigne-Postel score evaluated at the final follow-up was 14.6 (6-18), and the clinical outcomes were rated as excellent in six patients, good in 10 patients, fair in four patients, and poor in two patients, with an excellent and good rate of 72.7%. There were two cases of osteonecrosis of the femoral head (9%). No other complication was found for all cases.

CONCLUSION

The LRA is an effective and minimally invasive approach in the treatment of delayed acetabular fractures excluding posterior wall fracture and posterior dislocation.

摘要

目的

对于髋臼骨折延迟复位，手术入路一直存在争议。本研究旨在探讨单纯外侧直肌入路（LRA）行髋臼周围截骨术治疗髋臼骨折延迟复位的可行性、手术技术、安全性和疗效。

方法

回顾性研究纳入 2012 年 6 月至 2019 年 6 月收治的 22 例（男 16 例，女 6 例，平均年龄 45 岁）髋臼骨折延迟复位患者。所有患者均采用单纯 LRA 行髋臼周围截骨术。记录并分析骨折分型、致伤机制、合并伤、手术时间、术中出血量及并发症等。根据 Matta 影像学标准评估复位质量，分析影响复位质量的潜在因素。末次随访时，采用改良的 Mere D'Aubigne-Postel 评分系统对每位患者进行功能评估。

结果

所有患者均获得至少 12 个月随访。手术时间平均 140 min（110~~205 min），术中平均出血量 1250 ml（500~~2100 ml）。根据 Matta 影像学标准，7 例复位质量为“解剖复位”，11 例为“不满意复位”，4 例为“差”，优良率为 81.8%。复位质量差组的手术时间明显长于解剖复位或不满意复位组（p<0.05）。所有髋臼骨折均在 8~~12 周后愈合。末次随访时，改良 Merle D'Aubigne-Postel 评分平均为 14.6 分（6~~18 分），临床疗效评价为优 6 例，良 10 例，可 4 例，差 2 例，优良率为 72.7%。股骨头坏死 2 例（9%）。所有患者均未出现其他并发症。