微型接骨板联合重建接骨板与螺钉联合重建接骨板治疗髋臼后壁骨折的疗效比较  

Mini-plate plus reconstruction plate versus screws plus reconstruction plate for fractures of acetabular posterior wall

作　　者：潘昌武[1] 蔡贤华[1] 刘曦明[1] 汪国栋[1] 阮剑[2] 杜涛[2] 聂宇[3] 

机构地区：[1]广州军区武汉总医院骨科,430070 [2]湖北省黄冈市团风县人民医院骨科 [3]武汉军械士官学校医院

出　　处：《中华创伤骨科杂志》2015年第5期374-378,共5页Chinese Journal of Orthopaedic Trauma

基　　金：湖北省自然科学基金（2014CFC1052）;湖北省卫生计生西医类一般项目（WJ2015MB119）

摘　　要：目的 比较微型接骨板联合重建接骨板与螺钉联合重建接骨板治疗髋臼后壁骨折的临床疗效.方法 回顾性分析2007年3月至2013年9月收治的51例髋臼后壁骨折患者资料,根据内固定方式不同分为两组：微型接骨板组28例,男17例,女11例;平均年龄为（35.3±27.7）岁;采用微型接骨板联合重建接骨板固定.螺钉组23例,男14例,女9例;平均年龄为（38.5±25.8）岁;采用螺钉联合重建接骨板固定.所有患者均采用Kocher-Langenbeck入路手术.比较两组患者的手术时间、术中出血量、骨折复位质量、末次随访时髋关节改良Merle d＇Aubigne-Postel评分及术后并发症发生率等.结果 微型接骨板组与螺钉组患者术后分别获（15.4±5.1）、（18.7±4.2）个月随访.微型接骨板组患者的手术时间[（163.5±23.5） min]短于螺钉组患者[（204.2±42.2） min],术中出血量[（330.0±150.1） mL]少于螺钉组患者[（410.2±164.6） mL],末次随访时髋关节改良Merle d＇Aubigne-Postel评分[（16.5±1.9）分]高于螺钉组患者[（15.2±2.4）分],术后并发症发生率[21.4％ （6/28）]低于螺钉组患者[47.8％ （11/23）],差异均有统计学意义（P＜0.05）.但两组患者的骨折复位优良率分别为92.8％ （26/28）、87.0％ （20/23）,差异无统计学意义（P＞0.05）. 结论 微型接骨板联合重建接骨板与螺钉联合重建接骨板治疗髋臼后壁骨折均能获得满意的临床疗效,但前者的手术时间更短、创伤更小、术后并发症发生率更低,且患者术后髋关节功能恢复更好.Objective To compare mini-plate plus reconstruction plate versus screws plus reconstruction plate in the treatment of fractures of acetabular posterior wall.Methods From March 2007 to September 2013,51 patients with complex fracture of acetabular posterior wall were treated at our department.Twenty-eight patients received operation with mini-plate plus reconstruction plate （mini-plate group）.They were 17 males and 11 females,with an average age of 35.3 ±27.7 years.Twenty-three patients received operation with screws plus reconstruction plate （screws group）.They were 14 males and 9 females,with an average age of 38.5 ± 25.8 years.All the operations were conducted through the Kocher-Langenbeck approach.The 2 groups were similar in age,gender,injury side,injury cause,and time from injury to opera tion.The 2 groups were compared in terms of operation time,intraoperative bleeding,reduction,hip joint function at the last follow-up and postoperative complications.Results The mini-plate and screws groups obtained an average follow-up of 15.4 ±5.1 months and 18.7 ±4.2 months respectively.Compared with the screws group,the mini-plate group had significantly shorter operation time （163.5 ±23.5 min versus 204.2 ±42.2 min）,significantly less intraoperative bleeding （330.0 ± 150.1 mL versus 410.2 ± 164.6 mL）,significantly higher modified Merle d＇Aubigne-Postel scores at the last follow-up （16.5 ± 1.9 versus 15.2 ± 2.4）,and significantly lower postoperative complications [21.4% （6/28） versus 47.8% （11/23）] （all P 〈 0.05）.According to Matta evaluation system,there was no statistical significant difference in the excellent to good rate of reduction between the 2 groups [92.8% （26/28） versus 87.0% （20/23）] （P 〉 0.05）.Condusions Both mini-plate plus reconstruction plate and screws plus reconstruction plate can achieve satisfactory outcomes in treatment of complex fractures of acetabular posterior wall.However,the former may lead to shorter operation time,less invasion,lowe

关 键 词：髋臼 骨折 骨折固定术 内 骨板 骨钉 

分 类 号：R687.3[医药卫生—骨科学]