目的 分析腹直肌外侧入路（lateral-rectus approach，LRA）治疗儿童髋臼骨折的可行性、手术方法及临床疗效。 方法 回顾性分析2016年1月~2021年12月南方医科大学第三附属医院创伤骨科收治4例经LRA手术治疗儿童髋臼骨折患者的临床资料及随访情况，女性3例，男性1例，平均年龄12.5岁(10~15岁)，严重车祸伤3例，高处坠落伤1例，Letournel-Judet分型横形骨折1例；双柱骨折2例，前方伴后半横行骨折1例，合并骶髂关节脱位2例，合并骶骨骨折1例，合并耻骨联合分离3例。评估手术适应症及手术时机，4例均采用LRA治疗，术后按照Matta影像学复位评估标准评价复位效果，根据改良的Merle d’Aubigne-Postel评分系统评价髋关节功能。 结果 4例患者均顺利完成手术。无围手术期并发症发生，术后随访24~72个月，按照Matta影像学复位评估标准4例均解剖复位，4例患者骨折在2个月内均达到临床愈合标准及影像学愈合标准，根据改良的Merle d’Aubigne-Postel评分系统评价髋关节功能：优4例。4例末次随访髋臼形态结构正常，发育未见明显影响，行走及日常生活无异常，均已取出骨折内固定。 结论 需手术治疗的儿童髋臼骨折发生率极低，手术方法应选择尽可能微创的方式进行，本组4例均采用LRA完成手术，取得较好短期临床疗效。
Abstract
Objective To analyze the feasibility, surgical method and clinical effect of lateral rectus approach (LRA) in the treatment of acetabular fractures in pediatric. Methods The clinical data and follow-up of 4 pediatric patients with acetabular fracture treated by lateral rectus incision in the Trauma Department of the Third Affiliated Hospital of Southern Medical University from January 2016 to December 2021 were retrospectively analyzed, including 3 females and 1 male, with an average age of 12.5 years (10~15 years old), 3 severe car accident injuries and 1 fall injury from height. Based on Judet-Letournel classification, There were 1 case of transverse fracture, 2 cases of double-column fracture, 1 case of anterior column combined with posterior hemi transverse fractures, 2 cases of sacroiliac joint dislocation, 1 case of sacral fracture and 3 cases of symphysis pubis dissociation. The indications and timing of operation were evaluated. Four cases were treated with lateral rectus approach. The reduction effect was evaluated according to Matta imaging reduction evaluation criteria, and the hip joint function was evaluated according to the modified Merle d'Aubigne-Postel score system. Results The 4 patients completed the operation successfully. No perioperative complications occurred. During the follow-up of 24~72 months, 4 cases were anatomically reduced according to Matta imaging reduction evaluation criteria, and 4 cases of fractures reached clinical and imaging healing standards within 2 months. Hip joint function was evaluated according to the modified Merle d'Aubigne-Postel score system: excellent in 4 cases. During the last follow-up, the morphology and structure of acetabulum in 4 cases were normal, the development was not significantly affected, and there was no abnormality in walking and daily life, and the fracture internal fixation was removed. Conclusions The incidence of acetabular fracture in children who need surgical treatment is very low, and the surgical method should be minimally invasive as far as possible. Four cases in this group were operated by lateral rectus abdominis incision, and a good short-term clinical effect was obtained.
关键词
腹直肌外侧入路； /
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儿童； /
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髋臼骨折
Key words
Lateral-rectus approach; /
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Pediatric; /
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Acetabular fracture
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参考文献
[1] Liporace FA, Ong B, Mohaideen A, et al. Development and injury of the triradiate cartilage with its effects on acetabular development: review of the literature[J]. J Trauma, 2003, 54(6):1245-1249. DOI: 10.1097/01.TA.0000029212.19179.4A.
[2] Clutter SY, Morgan SJ, Erickson M, et al. Management of an open acetabular fracture in a skeletally immature patient[J]. Open Orthop J, 2007, 1:9-12. DOI: 10.2174/1874325000701010009.
[3] Passaplan C, Simonin A, Gautier E. Posterior wall acetabular fracture in a 13-year-old boy treated by open reduction and mini-plate internal fixation: long-term follow-up of 17 years[J]. Arch Orthop Trauma Surg, 2020, 140(9):1163-1167. DOI: 10.1007/s00402-019-03307-3.
[4] Quick TJ, Eastwood DM. Pediatric fractures and dislocations of the hip and pelvis[J]. Clin Orthop Relat Res, 2005(432):87-96. DOI: 10.1097/01.blo.0000155372.65446.40.
[5] Schlickewei W, Keck T. Pelvic and acetabular fractures in childhood[J]. Injury, 2005, 36 Suppl 1:A57-A63. DOI: 10.1016/j.injury.2004.12.014.
[6] Bhandari Mohit，王簕，杨云峰. 骨盆或髋臼骨折儿童与成人患者死亡率的比较[J]. 中华创伤骨科杂志, 2013, 15(4):341-344. DOI: 10.3760/cma.j.issn.1671-7600.2013.04.014.
[7] 曹扬，汪志明，施铁军，等. 儿童开放性浮髋损伤两例[J]. 中华创伤杂志, 2008, 24(3):187-189. DOI: 10.3321/j.issn:1001-8050.2008.03.
[8] 郑强，潘志军，黄宗坚. 不稳定性儿童骨盆骨折的内固定治疗[J]. 中华小儿外科杂志, 2005, 26(2):93-96. DOI: 10.3760/cma.j.issn.0253-3006.2005.02.011.
[9] 王娟，吴新宝，李明，等. 儿童不稳定骨盆骨折治疗的回顾分析[J]. 中华骨科杂志, 2011, 31(11):1203-1208. DOI: 10.3760/cma.j.issn.0253-2352.2011.11.006.
[10]陈伟，张奇，吕莉，等. 106例儿童骨盆骨折的回顾性分析[J]. 中华小儿外科杂志,2010,31(5):354-356.DOI: 10.3760/cma.j.issn.0253-3006.2010.05.010.
[11]洪潮，顾小华. 儿童开放性骨盆骨折耻骨联合分离合并左股骨近端骨折一例报告[J]. 中华骨科杂志, 2002, 22(4):198. DOI: 10.3760/j.issn:0253-2352.2002.04.020.
[12] Elmadag M, Acar MA. A modified stoppa (technique) approach for treatment of pediatric acetabular fractures[J]. Case Rep Orthop, 2013,478131. DOI: 10.1155/2013/478131.
[13]de Ridder VA, Olson SA. Operative Treatment of Pediatric Pelvic and Acetabulum Fractures[J]. J Orthop Trauma, 2019, 33 Suppl 8:S33-S37. DOI: 10.1097/BOT.0000000000001644.
[14] Guillaume JM, Pesenti S, Jouve JL, et al. Pelvic fractures in children (pelvic ring and acetabulum)[J]. Orthop Traumatol Surg Res, 2020,106(1S):S125-S133. DOI: 10.1016/j.otsr.2019.05.017.
[15] Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury[J]. J Bone Joint Surg Am, 1996, 78(11):1632-1645. DOI: 10.2106/00004623-199611000-00002.
[16] Heeg M, de Ridder VA, Tornetta PR, et al. Acetabular fractures in children and adolescents[J]. Clin Orthop Relat Res, 2000(376):80-86. DOI: 10.1097/00003086-200007000-00012.
[17] Grisoni N, Connor S, Marsh E, et al. Pelvic fractures in a pediatric level I trauma center[J]. J Orthop Trauma, 2002, 16(7):458-463. DOI: 10.1097/00005131-200208000-00003.
[18] Karunakar MA, Goulet JA, Mueller KL, et al. Operative treatment of unstable pediatric pelvis and acetabular fractures[J]. J Pediatr Orthop, 2005, 25(1):34-38. DOI: 10.1097/00004694-200501000-00009.
[19] Hearty T, Swaroop VT, Gourineni P, et al. Standard radiographs and computed tomographic scan underestimating pediatric acetabular fracture after traumatic hip dislocation: report of 2 cases[J]. J Orthop Trauma, 2011, 25(7):e68-e73. DOI: 10.1097/BOT.0b013e3181f9a7ba.
[20] Bucholz RW, Ezaki M, Ogden JA. Injury to the acetabular triradiate physeal cartilage[J]. J Bone Joint Surg Am, 1982, 64(4):600-609. DOI: 10.2106/00004623-198264040-00018.
[21] Judet R, Judet J, Lanzetta A, et al. [Fractures of the acetabulum. Classification and guiding rules for open reduction][J]. Arch Ortop, 1968, 81(3):119-158. PMID: 5746773.
[22] Igboechi O, Purtell SR, Carry P, et al. Pediatric Pelvic and Acetabular Fractures: Discerning Severity by Classification and Clinical Management[J]. J Pediatr Orthop, 2023, 43(7):424-430. DOI: 10.1097/BPO.0000000000002426.
[23] Bryan WJ, Tullos HS. Pediatric pelvic fractures: review of 52 patients[J]. J Trauma,1979, 19(11):799-805. DOI: 10.1097/00005373-197911000-00001.
[24] Heeg M, Klasen HJ, Visser JD. Acetabular fractures in children and adolescents[J]. J Bone Joint Surg Br, 1989, 71(3):418-421. DOI: 10.1302/0301-620X.71B3.2722933.
[25] Schwarz N, Posch E, Mayr J, et al. Long-term results of unstable pelvic ring fractures in children[J]. Injury, 1998, 29(6):431-433. DOI: 10.1016/S0020-1383(98)00074-6.
[26] Karunakar MA, Goulet JA, Mueller KL, et al. Operative treatment of unstable pediatric pelvis and acetabular fractures[J]. J Pediatr Orthop, 2005, 25(1):34-38. DOI：10.1097/00004694-200501000-00009.
[27] 刘涵，汪灿彬，陈家辉，等. 经腹直肌外侧入路髋臼翼形全万向锁定钢板固定治疗老年髋臼骨折[J]. 中华骨科杂志,2019,39(10):596-603. DOI: 10.3760/cma.j.issn.0253-2352.2019.10.002.
[28] 杨晓东，夏广，樊仕才，等. 单一腹直肌外侧切口治疗髋臼前后柱骨折[J]. 中华骨科杂志,2015,35(4):335-340. DOI：10.3760/cma.j.issn.0253-2352.2015.04.006.
[29] 李涛，汪灿彬，麦奇光，等. 腹直肌外侧入路结合术前3D打印技术治疗老年髋臼骨折[J]. 中华创伤骨科杂志, 2019, 21(6):516-523. DOI: 10.3760/cma.j.issn.1671-7600.2019.06.010.
[30] 杨晓东，刘涵，谷城，等. 髂坐钢板经腹直肌外侧入路治疗涉及方形区的髋臼骨折[J]. 中国矫形外科杂志, 2019, 27(20):1836-1840. DOI: 10.3977/j.issn.1005-8478.2019.20.03.
[31] 麦奇光，陈家辉，汪灿彬，等. 髋臼前后柱完整的股骨头中心性脱位一例报告[J]. 中华骨科杂志, 2019, 39(13):841-844. DOI: 10.3760/cma.j.issn.0253-2352.2019.13.009.
基金
国家自然科学基金（82072411）；国家骨科与运动康复临床医学研究中心创新基金（2021-NCRC-CXJJ-PY-06）；国家重点研发计划（2022YFC2504303）
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