前路特殊塑形钛板加方形区螺钉治疗伴有对侧骨盆前环不稳定波及双柱的髋臼骨折  

Both-column acetabular fracture with the secondary unstable anterior pelvic ring treated by internal fixation with reconstruction titanium plate combined with trans-plate quadrilateral screws via the ilioinguinal approach

作　　者：林冠林 陈庄洪[2] 蔡贤华[2] 刘曦明[2] 王华松[2] 张宝成[1] 

机构地区：[1]南方医科大学,广东广州510512 [2]广州军区武汉总医院骨科,湖北430070

出　　处：《创伤外科杂志》2016年第4期200-203,共4页Journal of Traumatic Surgery

基　　金：湖北省自然科学基金(2013CFA062)

摘　　要：目的探讨前路钛板结合方形区螺钉内固定治疗伴有对侧骨盆前环不稳定波及双柱的髋臼骨折的临床应用及疗效。方法回顾性研究广州军区武汉总医院2005年1月～2013年1月收治的涉及髋臼骨折的患者115例,按照髋臼骨折Judet-Letournel分型,收集其中一侧髋臼双柱骨折且伴对侧骨盆前环不稳定的患者19例,其中双柱骨折8例,T型骨折5例,横行骨折3例,前柱伴后半横骨折3例。男性12例,女性7例;年龄21～58岁,平均35.6岁。致伤原因：道路交通伤11例,重物砸伤5例,高处坠落伤3例。合并伤：失血性休克3例,肋骨骨折并血气胸3例,四肢骨折4例,腰椎压缩性骨折l例,腹部闭合性损伤2例,颅脑损伤1例。所有患者均采用仰卧位前路髂腹股沟入路,对侧骨盆前环不稳采用钢板螺钉固定,髋臼双柱骨折行重建钛板及经钛板3～5枚皮质骨螺钉（方形区螺钉）部分经骨表面内固定。术后应用Matta放射学标准评估骨折复位质量,定期随访,末次随访时采用改良Merle d’Aubigné和Postel评分标准评定髋关节功能。结果 19例患者均获得随访,随访时间12～36月,平均18.3个月。术后骨折复位质量按Matta评分：解剖复位11例,良好6例,不满意2例。所有患者骨折均获临床愈合,愈合时间为2～6个月,平均3.8个月。末次随访改良Merle d’Aubigné和Postel髋关节功能评分：优12例,良4例,可2例,差1例,优良率为84.2%。无一例发生方形区螺钉松脱、断裂。结论前路钛板结合方形区螺钉内固定是治疗以前柱损伤为主的髋臼双柱骨折有效方法之一,但对于伴对侧骨盆前环不稳定时,其有效固定的前提是先稳定对侧骨盆前环。Objective To explore the clinical efficacy of internal fixation using reconstruction titanium plate combined with trans-plate quadrilateral screws in the treatment of both-column acetabular fracture with unstable anterior pelvic ring on the other side via the ilioinguinal approach. Methods Of the 115 patients with acetabular fractures treated between Jan. 2007 and Jan. 2013,there were 19 cases with both-column fracture and unstable anterior pelvic ring on the other side according to Judet Letournel＇s classification. Of the 19 cases,8 were dual-column fracture,5 were T-shaped,3 were transverse and 3 were anterior column with transverse fracture. There were 12 males and 7 females,with an average age of 35. 6 years（ from 21 to 58 years）. Eleven were injured from traffic accident,5 from bruise and 3 from high falling. Three were associated with hemorrhagic shock,3 with rib fracture and hemopneumothorax,4 with limbs fracture,1 with lumbar vertebral compression fractures,2 with closed abdominal injuries and 1 with traumatic brain injury. All the fractures were treated with internal fixation using reconstruction titanium plate combined with 3 to 5 transplate conical screws（ quadrilateral screws） via the ilioinguinal approach after reduction. In some cases,the fixation was conducted via the bone surface. The quality of reduction was evaluated using the Matta＇s radiologic scoring system,while the hip functional recovery was evaluated using the modified Merle d＇Aubigné and Postel scoring system at the last follow up. Results All patients received follow-up of 12 to 36months（ average,18. 3months）. According to Matta＇s radiologic scoring system,ten patients achieved excellent anatomical reduction,seven with good functional reduction and two with dissatisfactory reduction. All the patients achieved fracture healing after 2 to 6 months（ average,3. 8 months）. In terms of functional recovery according to the modified Merle d＇Aubigné and Postel scoring system,12 patients were rated as excellent,4 as go

关 键 词：髋臼骨折 骨盆不稳 钛板塑形 螺钉 内固定 

分 类 号：R683[医药卫生—骨科学]