本文選題：髖臼骨折 + 外科手術(shù)��； 參考：《鄭州大學(xué)》2016年博士論文

【摘要】：髖臼骨折屬于關(guān)節(jié)內(nèi)骨折,后期髖關(guān)節(jié)功能的恢復(fù)和患者的滿意度均與關(guān)節(jié)面的復(fù)位質(zhì)量密切相關(guān)。經(jīng)典的髂腹股溝入路雖然可以應(yīng)用于除后壁骨折、后柱骨折、后柱合并后壁骨折、橫行合并后壁骨折外的其他六種類型骨折,但由于腹股溝韌帶的限制,采用該入路時(shí)無法顯露髖關(guān)節(jié),只能通過間接復(fù)位;而在植入螺釘時(shí)因無法直視關(guān)節(jié)面,即使借助術(shù)中透視,仍有可能誤入到關(guān)節(jié)內(nèi),因此對術(shù)者的手術(shù)經(jīng)驗(yàn)和復(fù)位技巧要求非常高。另外,術(shù)中對髂動(dòng)靜脈及其周圍淋巴組織的牽拉、剝離等易引起血管損傷、術(shù)后深靜脈血栓形成或術(shù)后淋巴漏;術(shù)中需要切開腹股溝管,如重建不佳可能導(dǎo)致術(shù)后腹股溝疝。針對以上不足之處,2008年Farid提出了髂腹股溝下入路,相比較傳統(tǒng)的髂腹股溝入路具有如下優(yōu)勢:(1)該入路通過髂嵴截骨的方式可以顯著擴(kuò)大外側(cè)窗,通過切斷縫匠肌和股直肌可以實(shí)現(xiàn)髖臼關(guān)節(jié)面的直視下復(fù)位;(2)在腹股溝韌帶下方分離結(jié)扎腹壁下動(dòng)脈和旋髂深動(dòng)脈,理論上可以避免死亡冠的損傷和減少術(shù)中出血;(3)無需切開腹股溝管,可以避免腹股溝直疝和斜疝的發(fā)生;(4)無需重建腹股溝管壁,因此閉合切口時(shí)間明顯縮短。然而我們在臨床實(shí)踐中發(fā)現(xiàn)該入路存在以下問題:(1)因需要切斷股外側(cè)皮神經(jīng)會(huì)引起術(shù)后灼性神經(jīng)痛或其支配區(qū)的感覺障礙;(2)縫匠肌和股直肌采用直接切斷于術(shù)畢進(jìn)行縫合重建,因術(shù)后制動(dòng)時(shí)間較長會(huì)影響術(shù)后康復(fù)及功能鍛煉;(3)采取在腹股溝韌帶下分離髂股血管進(jìn)行三窗顯露的方式并未減少對大血管的牽拉損傷;(4)對Fruchard孔下區(qū)完整性的破壞可能會(huì)誘發(fā)術(shù)后股疝的發(fā)生。因此,如何來減少或避免這些損傷以及由此導(dǎo)致的并發(fā)癥仍需要進(jìn)一步探討。第一部分:改良髂腹股溝下入路的解剖學(xué)研究目的總結(jié)髂腹股溝下入路所涉及的解剖結(jié)構(gòu)容易受損傷的原因,探討預(yù)防損傷的具體手術(shù)技巧及對該入路的改良方法。方法應(yīng)用20具成人尸體標(biāo)本,首先按照髂腹股溝下入路步驟切開、分離,然后針對臨床手術(shù)“三窗”顯露時(shí)涉及到的解剖結(jié)構(gòu)進(jìn)行上下延伸逐層解剖,觀察、測量、記錄相關(guān)解剖結(jié)構(gòu)走行、厚度、長度、角度及毗鄰關(guān)系,結(jié)合臨床操作分析其易損傷的原因及預(yù)防方法。結(jié)果髂腹股溝下入路三窗顯露時(shí)涉及到的結(jié)構(gòu)易受損傷的解剖特點(diǎn):1.髂腹下神經(jīng)和髂腹股溝神經(jīng)的外側(cè)段位于髂嵴上緣及髂結(jié)節(jié)內(nèi)側(cè),如切口外側(cè)段位置偏高易損傷;2.股外側(cè)皮神經(jīng)在髂前上棘內(nèi)側(cè)(22.35±1.65)mm穿腹股溝韌帶出骨盆,呈(80.56±10.53)°角入股部,距髂前上棘(43.45±2.26)mm自闊筋膜淺出,因走行角度、穿出骨盆和闊筋膜部位存在較多變異,如不能直視下分離則易受損傷;3.旋髂深動(dòng)脈31側(cè)(77.5%)起始于髂外動(dòng)脈,因此直接在腹股溝韌帶下尋找并結(jié)扎旋髂深動(dòng)脈較困難;4.縫匠肌與腹股溝韌帶下緣呈(40.23±5.35)°向內(nèi)下方斜行,覆蓋于股神經(jīng)和股動(dòng)靜脈前方,與股神經(jīng)外側(cè)邊分支交匯點(diǎn)到腹股溝韌帶下緣垂直距離約(20.13±6.02)mm,與股動(dòng)脈交匯點(diǎn)到腹股溝韌帶下緣的距離約(60.03±10.12)mm。縫匠肌、腹股溝韌帶和髂恥弓三者對股神經(jīng)和髂股血管起到保護(hù)和約束作用,術(shù)閉需要良好重建;5.腹壁下動(dòng)脈23側(cè)(57.5%)起自于髂外動(dòng)脈,發(fā)出點(diǎn)到腹股溝韌帶上緣的距離約為(8.81±3.02)mm,術(shù)中直接結(jié)扎該血管時(shí)易導(dǎo)致?lián)p傷;6.髂股血管前方與腹股溝韌帶后壁結(jié)合較緊密,在腹股溝韌帶下分離髂股血管并不能減少損傷;7.閉孔神經(jīng)入小骨盆口處距離骨壁(10.18±2.44)mm,中點(diǎn)處距離骨壁(12.23±0.84)mm,骨折移位或顯露四邊體時(shí)易受損傷;8.Fruchard孔下區(qū)為近似四邊形結(jié)構(gòu),存在多個(gè)薄弱部位,髂腹股溝下入路對其造成的廣泛破壞因難以重建而易誘發(fā)多種股疝發(fā)生;9.腹壁下動(dòng)脈與閉孔動(dòng)脈的吻合支距離陷窩韌帶約(10.65±3.22)mm,直接切開陷窩韌帶顯露內(nèi)側(cè)窗時(shí)易導(dǎo)致?lián)p傷。入路改良的解剖基礎(chǔ):1.髂恥弓總長約(31.25±1.42)mm,與髂恥隆起連接處致密,不易完整剝離。與腹股溝韌帶內(nèi)側(cè)半呈(22.83±5.79)°夾角,僅有疏松的結(jié)締組織充填,容易剝離分開;而夾角頂點(diǎn)距離股動(dòng)脈外側(cè)緣約(18.66±2.35)mm,左右側(cè)比較無顯著性差異(P0.05),在此處切開不易損傷股動(dòng)脈。2.整體觀髂筋膜在整個(gè)髂窩內(nèi)呈一凹陷的近似四邊體結(jié)構(gòu),近側(cè)端較薄弱,向遠(yuǎn)端則逐漸增厚。髂筋膜深面及表面有髂肌、腰大肌、股神經(jīng)和股外側(cè)皮神經(jīng);生殖股神經(jīng)和閉孔神經(jīng)穿髂筋膜處較高,在髂窩處位于髂筋膜前方;髂血管及其周圍淋巴組織、旋髂深動(dòng)脈腹股溝段位于髂筋膜前方。只要保持髂筋膜完整,在其下方分離不會(huì)傷及上述結(jié)構(gòu)。3.陷窩韌帶游離緣厚度僅為(0.23±0.11)mm,結(jié)構(gòu)薄弱,但其與恥骨肌筋膜一同附著于恥骨上支上方,附著點(diǎn)筋膜厚度為(2.23±1.35)mm,結(jié)構(gòu)致密,可于此處完整剝離骨膜及筋膜后放置鋼板。結(jié)論1、采用髂腹股溝下入路治療髖臼骨折,手術(shù)切口及三窗顯露時(shí)易對髂腹下神經(jīng)、髂腹股溝神經(jīng)、股外側(cè)皮神經(jīng)、股神經(jīng)、閉孔神經(jīng)、生殖股神經(jīng)、旋髂深動(dòng)脈、腹壁下動(dòng)脈及其吻合支造成損傷;并不能減少髂股血管及周圍淋巴組織的牽拉傷;易對Fruchard孔下區(qū)造成損傷,誘發(fā)術(shù)后股疝等并發(fā)癥。2、髂筋膜與周圍解剖結(jié)構(gòu)關(guān)系密切,對于髂腹股溝下入路,可以通過髂前上棘截骨,于髂筋膜下顯露外側(cè)窗,輔以內(nèi)側(cè)小切口顯露恥骨上支的方法進(jìn)行改良,減少或避免相關(guān)的并發(fā)癥。第二部分:應(yīng)用髂腹股溝下入路與改良入路治療髖臼前部簡單骨折的療效比較目的比較應(yīng)用髂腹股溝下入路與改良入路治療髖臼前部骨折的療效。方法回顧性分析13例應(yīng)用改良的髂腹股溝下入路(A組)和21例應(yīng)用髂腹股溝下入路(B組)治療的髖臼前部骨折(前壁、前柱和橫行骨折)的臨床資料。對兩組的手術(shù)時(shí)間、術(shù)中出血量、Matta放射學(xué)評(píng)分的優(yōu)良率及骨折的愈合時(shí)間進(jìn)行比較。比較兩組最后隨訪時(shí)的改良d’Aubigné-Postel功能評(píng)分和髖關(guān)節(jié)的活動(dòng)度。結(jié)果兩組患者的性別、年齡、骨折分型、自受傷到手術(shù)的間隔時(shí)間差別均無統(tǒng)計(jì)學(xué)意義,具有可比性(P0.05)。A組的手術(shù)時(shí)間平均為90min(60~160min),B組為110min(90~210min),兩組之間差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05);A組的平均失血量為530m L(400~1050m L),B組平均為830m L(600~1250m L),兩組差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。A組和B組的骨折愈合時(shí)間分別為20w(14~23w)和22w(15~25w);Matta放射學(xué)評(píng)分優(yōu)良率分別為84.61%和90.48%;改良d’Aubigné-Postel評(píng)分優(yōu)良率分別為92.30%和90.48%;關(guān)節(jié)活動(dòng)度A組前屈(103.34±10.27)°后伸(10.23±5.12)°,B組前屈(106.13±12.33)°后伸(11.01±3.12)°。兩組Matta放射學(xué)評(píng)分優(yōu)良率、骨折愈合時(shí)間、改良d’Aubigné-Postel功能評(píng)分和髖關(guān)節(jié)活動(dòng)度無顯著性差異(P㧐0.05)。A組1例脂肪液化、3例腿肌間靜脈血栓,無切口感染、神經(jīng)損傷或麻痹、術(shù)后淋巴漏、內(nèi)固定松動(dòng)等并發(fā)癥,B組21例均出現(xiàn)股外側(cè)皮神經(jīng)麻痹癥狀,另有2例脂肪液化、2例深靜脈血栓、3例小腿肌間靜脈血栓、3例術(shù)后淋巴漏和5例隱性股疝。結(jié)論與髂腹股溝下入路相比,應(yīng)用改良髂腹股溝下入路治療髖臼前部骨折可以避免股外側(cè)皮神經(jīng)損傷,減少并發(fā)癥,并在縮短手術(shù)時(shí)間,減少出血量方面具有優(yōu)勢。第三部分:應(yīng)用改良髂腹股溝下入路治療髖臼復(fù)雜骨折的臨床研究目的探討應(yīng)用改良髂腹股溝下入路即髂筋膜下顯露外側(cè)窗聯(lián)合內(nèi)側(cè)小切口顯露恥骨上支的方法治療髖臼復(fù)雜骨折的可行性及臨床療效。方法2012年1月到2015年6月采用改良髂腹股溝下入路治療22例髖臼復(fù)雜骨折,男12例,女10例,年齡22~56歲,平均37.0歲。根據(jù)Judet-Letournel分類:T形骨折4例,前柱合并后半橫形骨折5例,雙柱骨折13例。采用單一改良髂腹股溝下入路19例,聯(lián)合Kocher-Langenbeck入路3例。應(yīng)用Matta放射學(xué)標(biāo)準(zhǔn)評(píng)價(jià)術(shù)后復(fù)位情況;改良d’Aubigné-Postel評(píng)分系統(tǒng)評(píng)價(jià)髖關(guān)節(jié)功能。結(jié)果22例患者手術(shù)時(shí)間平均110min(80~210min);出血量平均770m L(650~1250m L)。術(shù)后出現(xiàn)3例脂肪液化,5例小腿肌間靜脈血栓,5例深靜脈血栓。無切口感染、坐骨神經(jīng)、股神經(jīng)及股外側(cè)皮神經(jīng)損傷表現(xiàn)及術(shù)后淋巴漏。22例患者獲得平均18個(gè)月(8~22個(gè)月)隨訪,骨折平均愈合時(shí)間為22周(14~26周)。術(shù)后骨折復(fù)位質(zhì)量根據(jù)Matta放射學(xué)標(biāo)準(zhǔn)評(píng)定:優(yōu)11例,良5例,可3例,差3例,優(yōu)良率(72.73%)。最后隨訪時(shí)間無內(nèi)固定松動(dòng)、斷裂及腹股溝區(qū)疝,根據(jù)改良的d’Aubigné-Postel評(píng)分系統(tǒng):優(yōu)13例,良5例,可3例,差1例,優(yōu)良率(81.82%)。評(píng)價(jià)為差的1例患者于術(shù)后9個(gè)月出現(xiàn)FicatⅣ期股骨頭壞死,行全髖關(guān)節(jié)置換術(shù)。結(jié)論改良髂腹股溝下入路廣泛的顯露不但保障了前柱及前壁的直視下復(fù)位和固定,也利于后柱螺釘?shù)臏?zhǔn)確置入,可以應(yīng)用于髖臼復(fù)雜骨折的一些亞型。結(jié)合完善的術(shù)前準(zhǔn)備,術(shù)后感染、血腫、深靜脈血栓等并發(fā)癥的預(yù)防以及正確的康復(fù)訓(xùn)練可以取得理想的療效。
[Abstract]:The fracture of the acetabulum belongs to the intra-articular fracture. The recovery of the posterior hip function and the satisfaction of the patients are closely related to the quality of the articular surface reduction. The classic iliac inguinal approach can be applied to the posterior wall fracture, posterior column fracture, posterior wall fracture, and other six types of fractures outside the posterior wall fracture, but the abdomen is due to the abdomen. The limitation of the groin ligament is that the hip joint can not be exposed at the time of the approach, only by indirect reduction, but the inability to look at the articular surface when the screw is implanted, even with the help of intraoperative fluoroscopy, is still possible to enter the joint. Therefore, the operation experience and the reduction skills are not often high. In addition, the iliac vein and its peripheral lymph nodes are used in the operation. Retraction, divestiture, etc. easily cause vascular damage, deep venous thrombosis or postoperative lymphatic leakage; intraoperative incision of the groin tube, such as poor reconstruction, may lead to postoperative inguinal hernia. For the above deficiencies, the lower iliac inguinal approach was proposed by Farid in 2008 compared with the traditional iliac approach: (1) the following advantages The lateral window can be significantly expanded through the osteotomy of the iliac crest. The reduction of the articular surface of the acetabulum can be achieved by cutting the sartorius and the rectus femoris. (2) the ligation of the lower abdominal artery and the deep iliac artery under the inguinal ligament can theoretically avoid the injury of the dead crown and reduce the intraoperative bleeding; (3) no inguinal canal is not needed. It is possible to avoid direct inguinal hernia and oblique hernia; (4) there is no need to reconstruct the wall of the inguinal canal, so the closure of the incision is obviously shortened. However, we found the following problems in clinical practice: (1) the need to cut the lateral femoral cutaneous nerve to cause postoperative burning nerve pain or the sensory disturbance in its dominating area; (2) the sartorius and rectus femoris The postoperative rehabilitation and functional exercise can be affected by a long period of closure with a longer period of brakes. (3) the way to separate the iliac femoral vessels under the inguinal ligament for the three window exposure does not reduce the traction damage to the large vessels; (4) the damage to the integrity of the suborifice of the Fruchard may induce the post operative hernia. Therefore, how to reduce or avoid these injuries and the resulting complications still need to be further explored. Part 1: to improve the anatomical study of the inferior inguinal approach, to summarize the causes of the anatomical structures involved in the inferior inguinal approach, and to explore the specific surgical techniques for the prevention of injury and the approach to this approach. Methods 20 adult cadavers were used to cut and separate the specimens according to the procedure of the iliac inguinal approach. Then the anatomical structures involved in the clinical operation "three windows" were dissected, observed, measured, and recorded the related anatomical structure, thickness, length, angle and adjacent relationship, combined with clinical exercises. Results the causes and prevention methods of the injuries were analyzed. Results the anatomical features of the structures involved in the three window of the ilio inguinal approach were revealed: 1. the lateral segment of the iliac inferior nerve and the ilio inguinal nerve located at the upper iliac crest and the medial iliac nodules, such as the high location of the lateral incisional segment, and the 2. femoral lateral cutaneous nerve in the anterior superior iliac spine. The lateral (22.35 + 1.65) mm of the inguinal ligament was out of the pelvis, (80.56 + 10.53) angle into the femoral part, and from the anterior superior iliac spine (43.45 + 2.26) mm from the fascia. There were many variations in the position of the pelvis and the fascia lata because of the walking angle, for example, it was easy to be damaged in the part of the pelvis and the fascia lata; the 31 side of the 3. deep iliac artery (77.5%) started from the external iliac artery, so it was directly in the middle of the iliac artery. It is difficult to find and ligate the deep iliac artery under the inguinal ligament; the 4. sartorius muscle and the inferior inguinal ligament are (40.23 + 5.35) degrees inward, covering the femoral nerve and the femoral vein. The vertical distance from the lateral branch of the groin to the inferior edge of the inguinal ligament is about (20.13 + 6.02) mm, and the intersection of the femoral artery to the groin is toughened. The distance of the lower margin (60.03 + 10.12) mm. sartorius, inguinal ligaments and iliac iliac arches played a protective and binding role in the femoral and iliac femoral vessels, and the operation closed to a good reconstruction; the 5. abdominal inferior artery 23 (57.5%) from the external iliac artery, the distance from the point to the inguinal ligament was about (8.81 + 3.02) mm, and the blood was directly ligated during the operation. Guan Shiyi caused injury; 6. the front of the iliac ligament was closely associated with the posterior ligament of the inguinal ligament, and the separation of the iliac femoral vessels under the inguinal ligament could not reduce the damage; 7. the obturator nerve was located at the mouth of the bone (10.18 + 2.44) mm, and the middle point was distance from the bone wall (12.23 + 0.84) mm. The fracture was displaced or exposed to the quadrangular body, and the 8.Fruchard hole was easily damaged. The lower region is an approximate quadrilateral structure, and there are many weak parts. The extensive destruction caused by the inferior inguinal approach is easy to induce multiple inguinal hernia. The anastomosis branch of the inferior wall artery and the closed artery of the 9. abdomen is about (10.65 + 3.22) mm, and the direct incision of the lacunae ligament exposes the medial window to the injury. Good anatomical basis: 1. the total length of the 1. iliac arch is about (31.25 + 1.42), which is dense and not easy to peel off with the iliac hump. It is half (22.83 + 5.79) angle with the inside of the inguinal ligament, only loose connective tissue is filled and easily stripped and separated, but the angle of the apex is about (18.66 + 2.35) mm, and there is no significant difference between the left and right sides. P0.05, the incision is not easy to damage the femoral artery.2. as a whole, and the iliac fascia in the whole iliac fossa is an approximate quadrangular structure in the whole iliac fossa. The proximal end is weak, and gradually thickens to the distal end. The deep surface and surface of the iliac fascia have iliac muscle, the psoas muscle, the femoral nerve and the lateral femoral cutaneous nerve; the genital and obturator nerve and the iliac fascia are higher. The iliac fossa is located in front of the iliac fascia; the iliac vessel and its peripheral lymphatic tissue and the inguinal segment of the deep iliac artery are located in front of the iliac fascia. As long as the iliac fascia is intact, the separation below it will not hurt the thickness of the free margin of the.3. lacunar ligament (0.23 + 0.11) mm and the structure is weak, but it is attached to the suprapubic branch with the pubis myofascial membrane. Above, the thickness of the attachment point was (2.23 + 1.35) mm, and the structure was dense, and the plate could be placed after the entire periosteum and fascia. Conclusion 1, the iliac inguinal approach was used to treat the acetabular fracture. The surgical incision and the three window were easily exposed to the iliofabastric nerve, the ilio inguinal nerve, the lateral femoral cutaneous nerve, the femoral nerve, the obturator nerve and the reproduction of the femoral nerve. The deep iliac artery, inferior epigastric artery and its anastomotic branch are damaged, and it can not reduce the traction of the iliac femoral vessels and peripheral lymphatic tissue; it is easy to cause damage to the suborifice of the Fruchard and induce postoperative complications such as.2, the iliac fascia is closely related to the surrounding anatomy, and the inferior iliac inguinal approach can be used for the iliac anterior upper spine osteotomy and iliac iliac. Subfascial exposure of the lateral window with a small medial incision to expose the superior branch of the pubic symphysis to reduce or avoid related complications. Second part: comparison of the efficacy of the inferior inguinal approach and improved approach for the treatment of simple fracture of the anterior acetabulum; the application of the iliac femoral subtrench approach and improved approach for the treatment of the anterior acetabular fracture Methods the clinical data of 13 cases of the modified iliac inferior inguinal approach (group A) and 21 cases of the anterior, anterior and transverse fractures of the acetabulum treated by the inferior inguinal approach (group B) were retrospectively analyzed. The operative time, the amount of intraoperative bleeding, the good rate of Matta radiological score and the healing time of the fracture were compared between the two groups. Compared with the improved d 'Aubign e -Postel function score and the hip joint activity at the last follow-up of the two groups. Results there were no significant differences in the sex, age, fracture type and interval between the two groups of patients and the interval between the injury to the operation, and the average operation time of the.A group was 90min (60~160min), and the B group was 110min (90~210min). The difference between the two groups was statistically significant (P? 0.05); the average blood loss in the group A was 530m L (400~1050m L), the average of the B group was 830m L (600~1250m L), and the two groups were statistically significant (P? 0.05) and the fracture healing time was 84.61% and 90.48% respectively. The excellent rate of -Postel score was 92.30% and 90.48%, joint activity A (103.34 + 10.27) degrees (10.23 + 5.12) degrees, B group forward flexion (106.13 + 12.33) degrees (11.01 + 3.12) degrees. The excellent rate of Matta radiology score, fracture healing time, improved d 'Aubign e -Postel function score and hip joint activity were no significant difference (P? 0) 5) in group.A, 1 cases of fat liquefaction, 3 cases of intermuscular venous thrombosis, no incision infection, nerve injury or paralysis, postoperative lymphatic leakage, internal fixation loosening and other complications, 21 cases in group B all had lateral femoral cutaneous nerve paralysis, 2 cases of fat liquefaction, 2 cases of deep venous thrombosis, 3 cases of intermuscular venous thrombosis, 3 cases of postoperative lymphatic leakage and 5 recessive hernia. Compared with the inferior inguinal approach, the modified iliac inguinal approach in the treatment of the anterior acetabular fracture can avoid the lateral femoral cutaneous nerve injury, reduce the complications, and have advantages in shortening the operation time and reducing the amount of bleeding. The third part: the clinical study of the modified iliac inferior groin approach for the treatment of the complex fracture of the acetabulum The feasibility and clinical efficacy of the modified iliac inferior inguinal subfascia under the external iliac fascia exposed to the lateral window and the small medial incision to reveal the superior branch of the pubis in the treatment of the complex fracture of the acetabulum. Methods from January 2012 to June 2015, the modified iliac inguinal approach was used to treat 22 cases of complex fracture of the acetabulum, 12 males and 10 females, with an average age of 37. years, averaging 37.. 0 years old. According to Judet-Letournel classification: 4 cases of T shaped fracture, 5 cases of anterior column with posterior semi transverse fracture and 13 cases of double column fracture. 19 cases with single improved iliac inferior inguinal approach and 3 cases with Kocher-Langenbeck approach were used to evaluate the postoperative reduction with Matta radiology standard; the modified D 'Aubign e -Postel scoring system was used to evaluate hip function. 22 results 22 The average operation time of the patients was 110min (80~210min), the average bleeding volume was 770m L (650~1250m L). 3 cases of fat liquefaction, 5 cases of intermuscular venous thrombosis, 5 cases of deep venous thrombosis, no incision infection, sciatic nerve, femoral nerve and lateral femoral cutaneous nerve injury, and postoperative lymphatic leakage of.22 cases were followed up for 18 months (8~22 months). The average healing time of fracture was 22 weeks (14~26 weeks). The quality of fracture reduction was evaluated according to Matta radiological criteria: excellent 11 cases, good 5 cases, 3 cases, 3 poor cases, excellent rate (72.73%). The final follow-up time had no internal fixation loosening, fracture and inguinal hernia, according to improved d 'Aubign e -Postel scoring system: excellent 13 cases, good 5 cases, 3 cases, 1 cases, poor 1 case, fine 1 cases, fine 1 cases, excellent and good Rate (81.82%). 1 patients with poor evaluation appeared Ficat IV necrosis of the femoral head and total hip replacement at 9 months after operation. Conclusion the extensive exposure of the improved inferior inguinal approach not only protects the immediate reduction and fixation of the anterior and anterior walls, but also facilitates the accurate placement of the posterior column screws, which can be applied to some of the complicated acetabular fractures. Combination of comprehensive preoperative preparation, postoperative infection, hematoma, deep vein thrombosis and other complications prevention and proper rehabilitation training can achieve satisfactory results.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.3;R322.7

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