Zhang Jin, Shen Jian-Jun, Hai Xiang, Liu Chuan-Yuan, Zhou Wen-Jie, Chen Zhi-Wei
Second Trauma Department of Gansu Provincial Hospital of TCM, Lanzhou 730050, Gansu, China.
Gansu University of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China.
Zhongguo Gu Shang. 2024 Aug 25;37(8):786-92. doi: 10.12200/j.issn.1003-0034.20221109.
To compare the clinical efficacy of the posterior hemipelvectomy of the greater trochanter approach with the standard Kocher-Langenbeck(K-L) approach in the treatment of posterior acetabulum wall fractures and to explore a more optimal approach for the treatment of posterior acetabulum wall fractures.
Total of 26 patients with posterior acetabulum wall fractures were retrospectively analysed and divided into two groups:the posterior hemipelvectomy of the greater trochanter group (test group) and the standard K-L approach group (control group). In the test group, there were 24 patients including 16 males and 8 females with an average age of (42.00±4.52) years old, the time of injury to surgery was (6.75±1.15) d. In the control group, there were 23 patients including 16 males and 7 females with an average age of (41.00±5.82) years old, the time of injury to surgery was (7.09±1.20) days. The total hospital stay, length of incision, operation time, intraoperative bleeding, postoperative drainage, discharge, fracture reduction quality (Matta criteria), hip abduction muscle strength, hip function (Merle d'Aubigne-Postel score), postoperative complications and the incidence of ectopic ossification were compared.
All cases were followed up for 6 months. There was no significant difference in incision length, intraoperative bleeding and postoperative drainage between two groups(>0.05). However, the operation time of the test group was shorter than that of the control group (<0.05). There was no statistically significant difference in fracture reduction and hip function between two groups (>0.05). The hip abduction muscle strength of test group was better than that of control group(<0.05). In addition, there was no significant difference in the incidence of postoperative complications and heterotopic ossification between two groups(>0.05).
Compared with the standard K-L approach, the posterior hemipelvectomy of the greater trochanter approach can shorten the operative time, has better recovery of the postoperative hip abduction muscle strength, exposes the view of the fracture involving the more comminuted posterior acetabulum wall or the fracture of the roof of the socket, improved the rate of fracture anatomical repositioning, provides a new idea for the clinical treatment of posterior acetabulum wall fractures, and allows patients to perform functional exercises at an early stage.
比较大转子入路半骨盆后切除术与标准Kocher-Langenbeck（K-L）入路治疗髋臼后壁骨折的临床疗效，探索治疗髋臼后壁骨折更优化的手术入路。
回顾性分析26例髋臼后壁骨折患者，分为大转子入路半骨盆后切除术组（试验组）和标准K-L入路组（对照组）。试验组24例，男16例，女8例，平均年龄（42.00±4.52）岁，受伤至手术时间（6.75±1.15）天。对照组23例，男16例，女7例，平均年龄（41.00±5.82）岁，受伤至手术时间（7.09±1.20）天。比较两组患者的总住院时间、切口长度、手术时间、术中出血量、术后引流量、出院情况、骨折复位质量（Matta标准）、髋关节外展肌力、髋关节功能（Merle d'Aubigne-Postel评分）、术后并发症及异位骨化发生率。
所有病例均随访6个月。两组切口长度、术中出血量及术后引流量比较，差异无统计学意义（>0.05）。试验组手术时间短于对照组（<0.05）。两组骨折复位及髋关节功能比较，差异无统计学意义（>0.05）。试验组髋关节外展肌力优于对照组（<0.05）。此外，两组术后并发症及异位骨化发生率比较，差异无统计学意义（>0.05）。
与标准K-L入路相比，大转子入路半骨盆后切除术可缩短手术时间，术后髋关节外展肌力恢复较好，能暴露髋臼后壁粉碎性骨折或髋臼顶骨折视野，提高骨折解剖复位率，为髋臼后壁骨折的临床治疗提供新思路，且能使患者早期进行功能锻炼。
