髂腹股沟微创切口内固定技术在骨盆骨折中的应用

目的研究采用髂腹股沟微创切口内固定技术治疗髋臼前柱或耻骨支骨折的疗效及特点。方法自2007年7月至2011年9月,对31例骨盆骨折患者（其中耻骨支骨折23例,髋臼前柱骨折8例）采用髂腹股沟微创切口内固定技术治疗。患者采用全麻或腰硬联合麻醉,取传统髂腹股沟入路的内外侧两端切口,分别自内外两个切口紧贴骨面向中间潜行剥离,相互贯通,形成耻骨支、髋臼前柱相通的隧道,并用骨膜剥离器撬拨扩大通道。根据通道内骨面预弯重建钛板,自外侧切口紧贴骨面插入预弯钛板,分别于钛板远近端钻孔拧入3枚左右螺钉固定钢板。结果本组患者获得5～29个月随访,平均14.1个月。骨折全部临床愈合。按照Matta复位标准,术后解剖复位14例,复位良好16例,复位较差1例,优良率96.7%。按照Majeed评分,优19例,良11例,可1例,优良率96.7%。无感染、股神经或股血管损伤、静脉血栓、异位骨化及骨关节炎和股骨头缺血坏死等并发症发生。结论应用髂腹股沟微创切口内固定技术治疗骨盆骨折,手术创伤小、手术时间短、手术安全性高、术后并发症少、功能恢复好。

Llioinguinal Minimally Invasive Incision in Pelvic Fracture Fixation Techniques

Objective To explore the efficacy and features of fixation techniques in fractures of acetabular column or pubic rami through minimally invasive incision ilioinguinal approach. Methods From July 2007 to September2011,31cases of patients with pelvic fractures（including pubic rami fracture in 23 cases,acetabular anterior caem fracture in 8 cases）were surgucally fixed through minimally invasive incision ilioinguinal approach. Patients usig, geaeral anesthesia or spinal and epidural anesthesia ,take both ends of the inner and outer incision traditional ilioinguinal approach, from both internal and external incision close to the bone-oriented intermediate sneak peel interconnected to form a pubic rami,acetabular anterior column interlinked the tunnel and periosteal stripping poking expand channel. Reconstruction plate channels within the bone surface,since the pre-bent titanium plate inserted the lateral incision close to the bone surface ,respectively,in the titanium plate proximal and distal holes screwed three screws steel. Re- sults All the patients were followed upo for 5 to 29 months with an average of 14.1 months. All fractures healed. According to Matta reset standards,there were anatomical reductions of the hip in14 cases,good in16 cases,poor in one cases. The excellent and good rate was 96.7 %. According to Majeed score ,excellent in 19 cases ,good in 11 cases, fair in 1 case,The excellent and good rate was 96.7%. No infection,injury of the femoral nerve ,femoral vein thrombo- sis,heterotopic ossification,osteoarthritis,avascular necrosis and other complications were found. Conclusion Frac- ture fixation through minimally invasive ilioinguinal aproach is a good choice for acetabular or pubic rami fracture.