摘要
目的探讨髂腹股沟入路治疗髋臼双柱骨折中应用矢量和概念进行后柱螺钉通道微调的效果。方法采用回顾性队列研究分析2015年7月至2021年5月潍坊市人民医院收治的42例髋臼双柱骨折患者临床资料, 其中男22例, 女20例;年龄23~77岁[(49.3±16.3)岁]。患者均采用髂腹股沟入路, 前柱采用钢板固定, 后柱采用后柱拉力螺钉固定。19例术中应用矢量和概念微调后柱螺钉通道(通道微调组):在后柱螺钉骨性通道内置入1枚2.5 mm克氏针, 分别透视髂骨斜位及闭孔斜位, 当单一透视面上克氏针未位于坐骨支中间时, 只需在单一方向上调整, 另一方向调整的矢量为0;当2个透视面上克氏针均未位于坐骨支中间时, 计算出2个方向的不良矢量和后再进行微调。23例术中未应用矢量和概念微调后柱螺钉通道(通道非微调组)。记录并比较两组后柱螺钉置入时间、术中出血量、导针调整次数、骨折愈合时间;术后6个月采用Matta评分评定骨折复位质量;术后6个月根据Merle D′Aubigné-Postel评分评定患髋功能;观察并发症情况。结果患者均获随访7~71个月[(35.7±8.5)个月]。通道微调组后柱螺钉置入时间为(5.1±1.5)min, 术中出血量为(798.8±83.9)ml, 导针调整次数为(1.8±0.5)次, 骨折愈合时间为(12.4±3.2)周, 显著短于或少于通道非微调组的(39.8±12.0)min、(1 119.3±172.0)ml、(5.6±1.6)次、(15.6±4.2)周(P<0.05或0.01)。两组术后6个月骨折复位质量与术后6个月患髋功能比较, 差异无统计学意义(P均>0.05)。术后7例出现股外侧皮神经症状;2例出现切口浅表感染, 经清创换药后愈合;3例出现下肢深静脉血栓。其中通道微调组术后并发症发生率为26%(5/19), 通道非微调组为30(7/23)(P>0.05)。结论髂腹股沟入路治疗髋臼双柱骨折中应用矢量和概念进行后柱螺钉通道的微调, 能够迅速地将螺钉置入骨性通道内, 显著减少术中出血并加快骨折
Objective To investigate the effect of vector sum concept in fine-tuning posterior column screw channel via ilioinguinal approach for the treatment of bi-column acetabular fracture.Methods A retrospective cohort study was conducted to analyze the clinical data of 42 patients with acetabular double column fracture admitted to Weifang People′s Hospital from July 2015 to May 2021,including 22 males and 20 females,aged 23-77 years[(49.3±16.3)years].The ilioinguinal approach was used in all patients with the anterior column fixed with a plate and posterior column fixed with a lag screw.The vector sum concept was used intraoperatively to fine-tune the posterior column screw channel in 19 patients(channel fine-tuning group):namely,a 2.5 mm Kirschner wire was inserted into the bony channel of the posterior column screw under fluoroscopy of iliac oblique and obturator oblique positions;when the Kirschner wire was not located in the middle of the ischial ramus under single fluoroscopy,the vector only needed to be adjusted in one direction,with zero in the other direction;when the Kirschner wire was not located in the middle of the ischial ramus under fluoroscopy of both the iliac oblique and obturator obturator oblique positions,the sum of the deviation vectors in the two directions was calculated before fine-tuning.The vector sum concept was not used to fine-tune the posterior column channel screw in 23 patients(channel non-fine-tuning group).The time of posterior column screw placement,intraoperative blood loss,frequency of guide wire adjustment and fracture healing time were recorded and compared between the two groups.At 6 months after operation,the quality of fracture reduction and hip function were assessed by Matta score and Merle D′Aubigne-Postel score,respectively.The complications were observed.Results All patients were followed up for 7-71 months[(35.7±8.5)months].In channel fine-tuning group,the time of posterior column screw placement was(5.1±1.5)minutes,with intraoperative blood loss of(798.8±83.9)ml,
作者
李洪涛
刘军
赵杰
王琦
霍达
王志强
任昆明
朱温帅
孙学成
Li Hongtao;Liu Jun;Zhao Jie;Wang Qi;Huo Da;Wang Zhiqiang;Ren Kunming;Zhu Wenshuai;Sun Xuecheng(Department of Traumatology and Orthopedics,Weifang People′s Hospital,Weifang 261000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2022年第8期734-740,共7页
Chinese Journal of Trauma
基金
潍坊市卫生健康委员会项目(WFWSJK-2021-007)。
关键词
髋臼
骨折固定术
内
骨钉
矢量和
Acetabulum
Fracture fixation,internal
Bone nails
Vector sum
