前方腹直肌外侧入路在儿童髋臼骨折治疗中的应用及临床疗效分析

doi:10.13418/j.issn.1001-165x.2023.6.17

摘要/Abstract

摘要： 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。

关键词: 腹直肌外侧入路； , , 儿童； , , 髋臼骨折

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.

Key words: Lateral-rectus approach; , , Pediatric; , , Acetabular fracture

中图分类号:

R683.3

叶书熙, 杨晓东, 李涛, 麦奇光, 王华, 樊仕才. 前方腹直肌外侧入路在儿童髋臼骨折治疗中的应用及临床疗效分析[J]. 中国临床解剖学杂志, 2023, 41(6): 728-732.

Ye Shuxi, Yang Xiaodong, Li Tao, Mai Qiguang, Wang Hua, Fan Shicai . Application and clinical effect analysis of lateral anterior rectus approach in the treatment of acetabular fractures in pediatric[J]. Chinese Journal of Clinical Anatomy, 2023, 41(6): 728-732.

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