Wang Xiao-Pan, Chen Xiao-Tian, Li Ren-Jie, Liu Le-Yu, Dai Xiu-Song, Guan Jian-Zhong, Wu Min, Chen Xiao-Dong
Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical University, Anhui Provincial Key Laboratory of Tissue Transplantation, Bengbu 233004, Anhui, China.
Zhongguo Gu Shang. 2024 Jul 25;37(7):706-12. doi: 10.12200/j.issn.1003-0034.20230928.
Evaluation of the clinical efficacy of f trochanteric flip osteotomy combined with Kocher-Langenbeck approach for high acetabular posterior wall fracture.
Between January 2020 and December 2022, 20 patients with high acetabular posterior wall fractures were retrospectively analyzed, including 12 males and 8 females, aged 18 to 75 years old. They were divided into two groups according to the different surgical methods. Ten patients were treated with greater trochanteric osteotomy combined with Kocher-Langenbeck approach as the observation group, including 5 males and 5 females, aged from 18 to 75 years old. Ten patients were treated with Kocher-Langenbeck approach alone as the control group, including 7 males and 3 females, aged from 18 to 71 years old. Matta reduction criteria were used to evaluate the reduction quality of the two groups, and Harris score was used to compare the hip function of the two groups at the latest follow-up. The operation time, blood loss and postoperative complications of the two groups were analyzed.
All patients were followed up for 10 to 24 months. According to the Matta fracture reduction quality evaluation criteria, the observation group achieved anatomical reduction in 6 cases, satisfactory reduction in 3 cases, and unsatisfactory reduction in 1 case, while the control group only achieved anatomical reduction in 3 cases, satisfactory reduction in 3 cases, and unsatisfactory reduction in 4 cases. At the final follow-up, the Harris hip score ranged from 71.4 to 96.6 in the observation group and 65.3 to 94.5 in the control group. According to the results of Harris score. The hip joint function of the observation group was excellent in 6 cases, good in 3 cases, and fair in 1 case. The hip joint function of the control group was excellent in 2 cases, good in 3 cases, fair in 3 cases, and poor in 2 cases. In the observation group, the intraoperative blood loss ranged from 300 to 700 ml, and the operation duration ranged from 120 to 180 min;in the control group, the intraoperative blood loss ranged from 300 to 650 ml, and the operation duration ranged from 100 to 180 min. Complications in the observation group included 1 case of traumatic arthritis and 1 case of heterotopic ossification, while complications in the control group included 3 cases of traumatic arthritis, 3 cases of heterotopic ossification and 1 case of hip abduction weakness.
Trochanteric flip osteotomy combined with the Kocher-Langenbeck approach significantly improved anatomical fracture reduction rates, enhanced excellent and good hip joint function outcomes, and reduced surgical complication incidence compared to the Kocher-Langenbeck approach alone. Clinical application of this combined approach is promising, although larger studies are needed for further validation.
评估股骨转子翻转截骨术联合Kocher-Langenbeck入路治疗髋臼高位后壁骨折的临床疗效。
回顾性分析2020年1月至2022年12月期间20例髋臼高位后壁骨折患者，其中男性12例，女性8例，年龄18至75岁。根据手术方法不同将患者分为两组。10例采用大转子截骨术联合Kocher-Langenbeck入路治疗作为观察组，其中男性5例，女性5例，年龄18至75岁。10例单纯采用Kocher-Langenbeck入路治疗作为对照组，其中男性7例，女性3例，年龄18至71岁。采用Matta复位标准评估两组的复位质量，采用Harris评分比较两组在末次随访时的髋关节功能。分析两组的手术时间、出血量及术后并发症。
所有患者均随访10至24个月。根据Matta骨折复位质量评估标准，观察组6例达到解剖复位，3例复位满意，1例复位不满意；而对照组仅3例达到解剖复位，3例复位满意，4例复位不满意。末次随访时，观察组Harris髋关节评分范围为71.4至96.6分，对照组为65.3至94.5分。根据Harris评分结果，观察组髋关节功能优6例，良3例，可1例。对照组髋关节功能优2例，良3例，可3例，差2例。观察组术中出血量为300至700 ml，手术时间为120至180分钟；对照组术中出血量为300至650 ml，手术时间为100至180分钟。观察组并发症包括1例创伤性关节炎和1例异位骨化，而对照组并发症包括3例创伤性关节炎、3例异位骨化和1例髋关节外展无力。
与单纯Kocher-Langenbeck入路相比，股骨转子翻转截骨术联合Kocher-Langenbeck入路显著提高了解剖复位率，增强了髋关节功能优良率，降低了手术并发症发生率。尽管需要更大规模的研究进行进一步验证，但这种联合方法在临床应用中具有前景。
