摘要
目的:评价股骨大转子截骨技术联合Kocher-Langenbeck入路治疗髋臼高位后壁骨折的临床疗效。方法:回顾分析2020年1月至2022年12月收治的髋臼高位后壁骨折患者20例,其中男12例,女8例;年龄18~75岁。根据手术方式的不同分为两组,10例采用股骨大转子截骨联合Kocher-Langenbeck入路为观察组,男5例,女5例,年龄18~75岁;10例单纯Kocher-Langenbeck入路为对照组,男7例,女3例,年龄18~71岁。使用Matta复位标准评价两组骨折的复位质量,末次随访时采用Harris评分比较两组患者髋关节功能。分析两组患者手术时间、失血量、术后并发症情况。结果:两组患者均获得随访,时间10~24个月。根据Matta骨折复位质量评价标准,观察组获解剖复位6例,满意复位3例,不满意复位1例;而对照组仅3例获解剖复位,满意复位3例,不满意复位4例。末次随访时,观察组髋关节Harris评分为71.4~96.6分,对照组为65.3~94.5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,优2例,良3例,可3例,差2例。观察组术中出血量300~700 ml,手术时间120~180 min;对照组术中出血量300~650 ml,手术时间100~180 min。观察组创伤性关节炎1例,异位骨化1例;对照组创伤性关节炎3例,异位骨化3例,髋外展无力1例。结论:通过对结果数据的分析,与单纯采用Kocher-Langenbeck入路相比,将股骨大转子截骨技术用于高位后壁骨折的治疗,能够有效提高骨折解剖复位率,提升髋关节功能优良率,同时降低手术并发症的发生,值得临床应用。但因样本量较少,未进行相关统计学分析,结论仍需要进一步的临床验证。
Objective Evaluation of the clinical efficacy of f trochanteric flip osteotomy combined with Kocher-Langenbeck approach for high acetabular posterior wall fracture.Methods 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.Results 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 controgroup. 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. Conclusions 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.
作者
王晓盼
陈笑天
李仁杰
刘乐予
代秀松
官建中
吴敏
陈晓东
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)
出处
《中国骨伤》
CAS
CSCD
2024年第7期706-712,共7页
China Journal of Orthopaedics and Traumatology
基金
安徽省卫生健康科研项目(编号:AHWJ2023A10086)
安徽高校自然科学研究项目(编号:KJ2021A0771)
蚌埠医学院自然科学基金重点项目(编号:2020byzd111)。
作者简介
通讯作者:吴敏,E-mail:635741385@qq.com。
