髋臼四方区组合钢板治疗老年髋臼骨折的有效性  

Efficacy of combinational plate in acetabular quadrilateral area for treatment of acetabular fractures in the elderly

作　　者：陈开放 杨帆[1] 郭晓东[1] 朱丰照 姚升 周锦鸽 Chen Kaifang;Yang Fan;Guo Xiaodong;Zhu Fengzhao;Yao Sheng;Zhou Jin＇ge.(Department of Orthopedics, Union Hospital, Tongfi Medical College, Huazhong University of Science and Technology, Wuhan 430022, Chin)

机构地区：[1]华中科技大学同济医学院附属协和医院骨科,武汉430022

出　　处：《中华创伤杂志》2018年第4期323-330,共8页Chinese Journal of Trauma

基　　金：国家重点研发计划重点专项（2016YFC1100100）;国家自然科学基金（81672158,81371939）

摘　　要：目的初步探讨髋臼四方区组合钢板结合术前3D打印技术治疗老年髋臼骨折的可行性和有效性。方法采用回顾性病例系列研究分析2016年8月-2017年6月收治的8例老年髋臼骨折患者临床资料，其中男5例，女3例；年龄60～68岁，平均64．2岁。根据Letournel-Judet分型：双柱骨折4例，“T”形骨折2例，前方伴后半横形骨折2例，其中3例合并后壁骨折。术前采用3D打印技术打印仿真骨盆模型，模拟髋臼四方区组合钢板的放置，钢板塑形备用。采用高位髂腹股沟入路，术中依次安放弓状缘内侧钢板、中柱钢板（耻坐钢板）、后柱钢板（髂坐钢板），分别固定前、中、后三柱，其中中柱钢板、后柱钢板均与弓状缘内侧钢板相组合。骨折复位后，内固定安放均一次完成。记录手术切口长度、手术时间、术中出血量。骨折复位按Matta标准评价，髋关节功能按改良Merle d＇Aubign6和Postel评分系统评分。观察并发症情况。结果患者均获随访3～12个月，平均6．8个月。手术切口长度8～12cm，平均10cm。手术时间100—180min，平均130min。术中出血量350—1000ml，平均600ml。骨折复位按Matta标准评价：优6例，良1例，可1例，优良率为7／8。末次随访髋关节功能：优4例，良2例，可1例，差1例，优良率为6／8。术中无一例出现医源性血管损伤、腹股沟疝或肺栓塞，术后无一例出现创伤性关节炎或股骨头缺血性坏死。结论髋臼四方区组合钢板由内向外的固定模式更加符合髋关节的生物力学特性，术后患者功能恢复良好，尤其适用于老年骨质疏松性髋臼四方区骨折；再结合3D打印技术进行术前规划，可进一步缩短手术时间、减少术中出血量及手术并发症的发生。Objective To investigate the feasibility and efficacy of combinational acetabular quadrilateral surface plates in treating elderly patients with acetabular fractures. Methods A retrospective case series study was conducted on the clinical data of eight elderly patients with acetabular fractures admitted between August 2016 and June 2017. There were five males and three females, with an average age of 64.2 years （range, 60-68 years）. According to the Letournel-Judet＇s classification, there were four patients with both column fractures, two T-shaped fractures, two anterior column and posterior hemitransverse fractures, among which three were combined with posterior wall fractures. Before operation, the artificial pelvis model was prepared by 3D printing for simulating the placement of combinational plates in the quadrilateral surface, and the plates were shaped for operation use. During operation, through the high iliac inguinal approach, the infrapectineal plate, pubo-ischiatic plate, and ilio-ischiatic plate were placed successively to fix anterior column, ＂middle column＂, and posterior column, respectively. The pubo-ischiatic and ilio-ischiatic plates were combined with the infrapectineal plate. After fracture reduction, internal fixation was completed at one time. The incision length, operation time, and intraoperative blood loss were recorded. Postoperative fracture reduction was evaluated by Matta standard, and function of hip joint by modified Merle d＇Aubign6 and Postel scoring system. The complications were recorded. Results All the patients were followed up for 3 12 months （mean, 6.8 months）. The average incision length was 10 cm （range, 8-12 cm）. The average operation time was 130 min （range, 100-180 rain）. The average blood loss was 600 ml （range, 350-1 000 ml）. According to the Matta standard, six patients got excellent result, one good, and one fair, with an excellent and good rate of 7/8. With respect to the hip joint function at the last follow up, the result was excellent

关 键 词：髋臼 骨折固定术 内 老年人 组合钢板 

分 类 号：R687.3[医药卫生—骨科学]