经髂腹股沟小切口内固定治疗髋臼前柱或耻骨支骨折课件

,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,经髂腹股沟小切口内固定治疗髋臼前柱或耻骨支骨折,Treatment of fractures of the acetabular anterior column or pubic rami via minimally invasive ilioinguinal approach,概述,概述,腹股沟入路（,The ilioinguinal approach,）,缺点：,创伤大，术中分离复杂，中间窗分离操作时易损伤血管和神经，,Letournel,等报道该入路并发症可高达,10%,。,概述,Stoppa,入路（,Stoppa approach,）,概述,Stoppa,入路（,Stoppa approach,）,Khoury,等采用,stoppa,入路治疗髋臼前柱骨折并发症高达,22%,25%,，约,90%,患者需加用髂窝入路，优良率为,89%,。,Khoury A,Weill Y,Mosheiff R,.The Stoppa approach for acetabular fracture.,Oper Orthop Traumatol,2012,24(4-5):439-48.,概述,改良髂腹股沟下入路（,Modified subinguinal approach,）：,概述,改良髂腹股沟下入路（,Modified subinguinal approach,）：,缺点：血管、神经损伤并发症,Farid YR.,The subinguinal retroperitoneal approach for fractures of the acetabulum:a modified ilioinguinal approach.,J Orthop Trauma.2008 Apr;22(4):270-5.,概述,改良髂腹股沟前入路,(,Modified ilioinguinal incision of anterior),approach,）：,概述,经腹直肌入路（,Lateral-rectus approach,）,熊染,张潇,李涛,等,.,经腹直肌外侧切口入路治疗髋臼骨折合并骨盆骨折,.,中华创伤骨科杂志,2014,16(5):385-390.,概述,改良,Stoppa,入路（,Modified,stoppa approach,）,Archdeacon MT,Kazemi N,Guy P,Sagi HC.,The modified Stoppa approach for acetabular fracture.,J Am Acad Orthop Surg.2011 Mar;19(3):170-5.,概述,为了有效地减少血管、神经损伤等并发症，我们采用了经髂腹股沟小切口治疗髋臼前柱或耻骨支骨折。,1 Ruchholtz S,Taeger G,Zettl R.,A novel two-incision minimally invasive method for the treatment of anterior acetabular fractures.,Unfallchirurg.2013 Mar;116(3):277-82.,2Ruchholtz S,Buecking B,Delschen A,et al.,The two-incision,minimally invasive approach in the treatment of acetabular fractures.,J Orthop Trauma.2013 May;27(5):248-55.,临床资料,20,10,年,6,月至201,3,年,1,月治疗髋臼前柱,13,例、耻骨支骨折,10,例。,男,15,例，女,8,例；年龄,21,67,岁，平均,38.5,岁。右侧,14,例，左侧,9,例，均为新鲜闭合骨折。,治疗方法,采用,经髂腹股沟小切口内固定,观察指标,Matta,标准评价复位情况,DAubigne,评分评价髋关节功能,Majeed,评分评定骨盆功能,结果,所有骨折均骨性愈合,按照,Matta,标准术后解剖复位,11,例，复位良好,10,例，复位较差,2,例,参照,DAubigne,评分评定髋关节功能：优,11,例，良,8,例，可,4,例，优良率为,82.6%,依据,Majeed,评分评定骨盆功能：优,10,例，良,11,例，可,2,，优良率为,91.3%,。,Cas,e1,M,62,Y,L,术前,X,线、,CT,Cas,e1,M,62,Y,R,L,术后第,1,天、,3,个月,X,线片,Cas,e2,M,37,Y,L,术前,X,线、,CT,片,Cas,e2,M,37,Y,L,术后第,1,天,术后,6,个月,Case,3,F,56,Y 双侧,术前、术后,X,线片,Case,4,F,42,Y,L,术前,X,线片,Case,4,F,4,2Y,R,术后第,1,天,术后,3,个月,本操作技术优点,不显露中间窗的，有效减少了股神经和血管并发症的发生率；,保持了腹股沟管的完整性，减少了男性精索损伤的发生率，防止了术后腹股沟疝的发生；,本操作技术优点,钛板放置在髂耻前柱，塑形较为简单，仅需要前后方向的预弯，侧方和旋转方向则无需预弯；,本操作技术优点,该入路创伤小，手术时间短，减少术中出血量；,钢板跨过髋臼，无需在髋臼附近置钉，避免了螺钉误入髋臼的风险，并有效减少了术中透视次数；,本操作技术要点,术中屈髋屈膝位，使髂腰肌、血管和神经松弛。,在外侧切口注意保护股外侧皮神经，在内侧切口注意保护精索或子宫圆韧带；,外侧和内侧切口内潜行骨膜下剥离；,钢板沿髂耻前柱放置；,本操作技术要点,依据放射检查选择合适的钢板，依据标本预弯；,术中复位不佳时，可通过预弯的钛板和螺钉的提拉进一步复位；,钛板两端至少有,2,枚螺钉固定。,