动力化前路方形区钛板螺钉系统内固定治疗涉及方形区的复杂髋臼骨折  

Treatment of complex quadrilateral surface fractures of the acetabulum by internal fixation with dynamic anterior plate-screw system

作　　者：徐应朋 蔡贤华 陈岩召 钱胜龙 Xu Yingpeng;Cai Xianhua;Chen Yanzhao;Qian Shenglong(Hubei University of Traditional Chinese Medicine,Wuhan 430065,China (working at the Department of Orthopaedics,General Hospital of Central Theater Command,Wuhan 430070,China);Department of Orthopaedics,General Hospital of Central Theater Command,Clinical Medical Research Center for Orthopaedic Trauma Treatment in Hubei Province,Wuhan 430070,China)

机构地区：[1]湖北中医药大学,武汉430065 [2]中部战区总医院骨科,湖北省骨创伤救治临床医学研究中心,武汉430070

出　　处：《中华创伤骨科杂志》2019年第6期464-470,共7页Chinese Journal of Orthopaedic Trauma

基　　金：湖北省技术创新专项项目(重大项目)(2017ACA099).

摘　　要：目的探讨动力化前路方形区钛板螺钉系统(DAPSQ)内固定治疗涉及方形区的复杂髋臼骨折的临床疗效。方法回顾性分析2005年1月至2017年1月期间中部战区总医院骨科收治的143例涉及方形区的复杂髋臼骨折患者资料。男86例,女57例;年龄为19~77岁,平均46.6岁。骨折按Letournel-Judet分型:前柱合并后半横形骨折38例,T形骨折26例,双柱骨折79例;均为闭合性骨折。受伤至手术时间为3~21d,平均9.6d。所有患者均采用单一髂腹股沟入路DAPSQ内固定。记录患者的手术时间、术中出血量、术后骨折复位质量、患髋功能及并发症的发生情况等。结果本组患者的手术时间为2.5~5.0h,平均3.8h;术中出血量为400~2500mL,平均680mL。术后骨折复位质量根据Matta评分标准评定:优76例,良51例,差16例,优良率为88.8%。143例患者术后获4个月至10年(平均4.1年)随访。骨折临床愈合时间为2~4个月,平均3个月。末次随访时根据改良Merled’Aubigné&Postel评分系统评定患髋功能:平均16.3分(9~18分);优64例,良52例,可19例,差8例,优良率为81.1%。术后并发症:股外侧皮神经损伤7例,泌尿系统感染15例,创伤性关节炎20例(全髋关节置换术5例),异位骨化5例(Brooker分级为Ⅰ级)。结论DAPSQ内固定治疗涉及方形区的复杂髋臼骨折安全、有效,疗效良好。Objective To explore the clinical efficacy of internal fixation with dynamic anterior plate-screw system for quadrilateral area(DAPSQ) in the treatment of complex acetabular fractures involving the quadrilateral surface. Methods Between January 2005 and January 2017, a series of 143 patients with complex quadrilateral surface fracture of the acetabulum were treated at Department of Orthopaedics, General Hospital of Central Theater Command. They were 86 males 57 females, with a mean age 46.6 years (range, from 19 to 77 years). By the Letournel-Judet classification, there were 38 anterior column plus posterior hemitransverse fractures, 26 T-shaped fractures and 79 double column fractures. They were all closed. The delay from injury to surgery averaged 9.6 days(range, from 3 to 21 days). All the cases were treated with DAPSQ internal fixation via the ilioinguinal approach. Their operation time, intraoperative bleeding volume, quality of fracture reduction, hip function and complications were recorded. Results The operation time for this series ranged from 2.5 to 5.0 hours, averaging 3.8 hours. The intraoperative blood bleeding ranged from 400 to 2,500 mL, with an average of 680 mL. By the Matta criteria for fracture reduction, 76 cases were rated as excellent, 51 as good and 16 as poor, giving an excellent and good rate of 88.8%. The 143 patients were followed up from 4 months to 10 years (mean, 4.1 years). The clinical fracture union was achieved after 2 to 4 months (mean, 3 months). By the modified Merle d’Aubigné& Postel criteria, the affected hips scored 9 to 18 points (mean, 16.3 points) at the final follow-ups, with 64 excellent, 52 good, 19 fair and 8 poor cases, giving an excellent and good rate of 81.1%. The postoperative complications included lesion of lateral femoral cutaneous nerve in 7 cases, urinary tract infection in 15 ones, traumatic osteoarthritis in 20 ones 5 of whom had to receive total hip arthroplasty, and heterotopic ossification (Brooker Grade Ⅰ) in 5 ones. Conclusion Internal fixation

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]