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目的:探讨直接后方入路经皮后柱通道螺钉及钢板固定治疗髋臼后方粉碎性骨折的疗效。方法:回顾性分析2016年1月至2020年7月采用直接后方入路经皮后柱通道螺钉及钢板固定治疗的髋臼后方粉碎性骨折患者36例，男28例、女8例；年龄（42.0±12.1）岁（范围19~64岁）。根据Letournel-Judet分型：横形伴后壁骨折28例、后柱伴后壁骨折6例、“T”形伴后壁骨折2例。患者取俯卧位直接后方入路，于直视下对髋臼前后柱骨折进行复位并以经皮后柱通道螺钉固定髋臼后柱，再复位髋臼后壁骨折并使用钢板及螺钉固定。记录手术时间、术中出血量、手术切口长度、骨折愈合时间、骨折复位质量（Matta的X线复位评估标准）、术后并发症发生情况及随访时的髋关节功能（改良Merle d\'Aubigne-Postel评分）。结果:36例均于直接后方入路下顺利完成骨折复位及固定。切口长度（9.8±1.2）cm（范围8~12 cm）；手术时间（102.9±21.4）min（范围65~145 min）；术中出血量（214.0±116.9）ml（范围100~640 ml）。术后X线及CT示髋臼骨折复位固定良好，按照Matta的X线复位评估标准：优28例、良6例、可2例，优良率94%（34/36）。全部病例获得随访，随访时间（20.9±9.2）个月（范围10~38个月）。骨折愈合时间（4.6±1.0）个月（范围3~6个月）。术中未发生医源性臀上神经及血管损伤。术后2例出现股骨头囊性变，但行走无疼痛；1例术后感染并继发菌血症，清创及抗感染治疗1个月后治愈；1例出现坐骨神经损伤，术后3个月恢复；1例于术后3个月出现异位骨化，不影响髋关节活动。术后1年改良Merle d\'Aubigne-Postel评分为优24例、良10例、可2例，优良率94%（34/36）。结论:直接后方入路切口小，能在直视下复位髋臼后方骨折；结合经皮后柱通道螺钉固定技术治疗髋臼后方粉碎性骨折具有创伤小及固定稳定的优势，早期临床疗效良好。“,”Objective:To investigate the surgical technique and the clinical effects of direct posterior approach (DPA) with the fixation of percutaneous tunnel screw and plate for acetabular posterior comminuted fractures.Methods:Thirty-six cases with acetabular posterior comminuted fractures treated by this technique from January 2016 to July 2020 were retrospectively analyzed in this study. There were 28 males and 8 female, aged 42.0±12.1 (range 19-64) years. According to Letournel-Judet classification, there were 28 cases of transverse associated with posterior wall fractures, 6 cases of posterior column with posterior wall fractures and 2 cases of T shape with posterior wall fractures. DPA was adopted in prone position. The anterior and posterior column fractures of the acetabulum were reduced under direct vision and then fixed with percutaneous tunnel screw. Further, the posterior wall fractures of the acetabulum were reduced and fixed with plate and screws. The operation duration, intraoperative blood loss, incision length, fracture union time, fracture reduction quality, postoperative complications and hip function were recorded.Results:The incision was 9.8±1.2 (range 8-12) cm. The operation duration was 102.9±21.4 (range 65-145) min. Intraoperative bleeding was 214.0±116.9 (range 100-640) ml. Postoperative X-ray and CT examinations showed perfect reduction. All the patients were followed up for 20.9±9.2 (range 10-38) months. The fracture healing time was 4.6±1.0 (range 3-6) months. There was no patient with damaged superior gluteal nerve and blood vessel. There were 2 cases of femoral head cystic changes without pain in walking, 1 case of postoperative infection and bacteremia who was cured at 1 month after debridement and anti-infection treatment, 1 case of sciatic nerve injury but recovered at 3 months after operation, and 1 case of heterotopic ossification at 3 months after surgery without affecting hip motion. According to the Matta\'s criteria, the reduction quality of the acetabular fracture was rated as excellent in 28 cases, good in 6 cases, fair in 2 cases. According to the modified Merle D\'Aubigné and Postel scoring system, hip joint function was excellent in 24 cases, good in 10 cases and fair in 2 cases.Conclusion:DPA approach can directly reduce acetabular posterior comminuted fractures through a minimal incision. Combined with the technique of percutaneous tunnel screw, it displays great advantages of less trauma and with good clinical effects.