复杂髋臼骨折的外科技术.doc

Safe surgicaltechnique for associated acetabular fractures复杂髋臼骨折的外科技术Takashi Suzuki,1?Wade R Smith,2?Cyril Mauffrey,3?and?Steven J Morgan2Author information ??Article notes ??Copyright and Licenseinformation ?AbstractAssociated acetabular fractures are challenging injuriesto manage. The complex surgical approaches and the technical difficulty inachieving anatomical reduction imply that the learning curve to achievehigh-quality care of patients with such challenging injuries is extremelysteep. This first article in theJournal’s?“Safe Surgical Technique” section presentsthe standard surgical care, in conjunction with intraoperative tips and tricks,for the safe management of all subgroups of associated acetabular fractures.复杂髋臼骨折的处理极具挑战性。为了获得解剖复位而需掌握的复杂外科入路和技术难点意味着学习曲线极其陡峭。本文介绍了标准外科技术、术中要点和技巧、各型复杂髋臼骨折的安全管理。Keywords:?Acetabular fractures,Safe surgical technique, Acetabular fixation, Patient safetyIntroductionThe anatomic reduction remains the rationale for thesurgical reduction and fixation of associated acetabular fractures, and is notdifferent from simple acetabular fracture patterns. However, the surgicalapproaches required, the ability to receive an anatomic reduction, and theapplication of rigid internal fixation techniques is more complex.不管复杂还是简单的髋臼骨折，理论上都要求解剖复位内固定，这没有什么区别。只不过从外科入路、解剖复位技巧到坚强内固定技术都更加复杂。Associated fractures, according to the Judet andLetournel classification [?1], are comprised oftwo or more fracture lines that pass through the acetabulum and have complexgeometries. With the exception of associated posterior column posterior wallpattern, the remaining associated fractures involve both the anterior andposterior columns. Due to the extensive involvement of both columns, the use ofan extensile surgical exposure to visualize and reduce these fractures has beenpreviously recommended. Compared to either the anterior or posterior approach,extensile exposures are associated with increased morbidity with respect tooperative time, blood