Stiehl J B, Harlow M, Hackbarth D
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee.
Clin Orthop Relat Res. 1993 Sep(294):162-9.
The triradiate approach as described by Mears has been used for open reduction of complex dual-column acetabular fractures. Mears extended the anterior limb of this incision to the symphysis pubis by the ilioinguinal approach. From a consecutive series of 43 total hip revisions, this approach was used successfully in seven cases in which extensile exposure was necessary to revise complicated acetabular reconstructions for arthroplasty. The approach was used also to perform complex acetabular reconstruction after en bloc tumor resection. Three patients had severe intrapelvic component protrusio and anterior column deficiency where close proximity of the prosthesis and femoral neurovascular bundle were detected before surgery. Massive allograft and pelvic reconstructions were used to span large anterior column defects and to stabilize pelvic dehiscence. Complications included one hip dislocation and one posterior flap tip necrosis. Follow-up ranged from six to 34 months. No graft failure has been noted.
米尔斯所描述的三辐射入路已用于复杂双柱髋臼骨折的切开复位。米尔斯通过髂腹股沟入路将该切口的前支延伸至耻骨联合。在连续的43例全髋关节翻修病例中，该入路成功应用于7例，这些病例需要广泛显露以翻修复杂的髋臼重建以进行关节成形术。该入路还用于整块肿瘤切除术后的复杂髋臼重建。3例患者存在严重的盆腔内组件突出和前柱缺损，术前发现假体与股神经血管束紧邻。使用大块同种异体骨移植和骨盆重建来跨越较大的前柱缺损并稳定骨盆裂开。并发症包括1例髋关节脱位和1例后皮瓣尖端坏死。随访时间为6至34个月。未发现移植失败。
