应用一体化髋臼四方区阻挡钢板治疗髋臼双柱骨折的疗效分析  

Treatment of acetabular both column fractures with integrated acetabular quadrilateral surface buttress plate

作　　者：姚升 陈开放 万意州 王玉龙 曾练 朱丰照 刘佳[2] 杨亮 郭晓东[1] Yao Sheng;Chen Kaifang;Wan Yizhou;Wang Yulong;Zeng Lian;Zhu Fengzhao;Liu Jia;Yang Liang;Guo Xiaodong(Department of Orthopaedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Radiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

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 [2]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《中华骨科杂志》2021年第15期1010-1017,共8页Chinese Journal of Orthopaedics

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：目的探讨应用一体化髋臼四方区阻挡钢板治疗髋臼双柱骨折的优缺点和临床疗效。方法回顾性分析2017年9月至2019年3月使用一体化髋臼四方区阻挡钢板治疗并获得随访的14例髋臼双柱骨折患者资料,男10例,女4例;年龄26~75岁,平均53.2岁;均为Letournel-Judet分型的双柱骨折,其中11例合并无后脱位的后壁骨折;受伤至手术时间8~19 d,平均10.3 d。手术均采用高位髂腹股沟入路,满意复位后以一体化髋臼四方区阻挡钢板同时固定髋臼前柱、四方区和后柱骨折。术后采用Matta标准评估骨折复位质量,采用改良的Merle d'Aubigné-Postel评分评定髋关节功能。结果手术时间120~320 min,平均180 min;术中出血量700~1600 ml,平均980 ml;一体化髋臼四方区阻挡钢板术中无需再次塑形,与骨表面均贴服良好。14例患者均获得随访,随访时间9~20个月,平均15.6个月;随访期间骨折均愈合,愈合时间2.5~5个月,平均3个月。Matta影像学评估显示解剖复位7例,满意复位5例,不满意复位2例,优良率85.7%(12/14);末次随访时改良Merle d'Aubigné-Postel评分为12~18分,平均16.9分,其中优8例、良4例、可2例,优良率85.7%(12/14)。术中1例患者分离精索时出现约1 cm腹膜破裂,即刻缝合修复;1例术后出现闭孔神经麻痹,未作特殊处理,术后6个月随访时麻痹症状缓解;余无其他手术相关并发症。结论双柱骨折采用一体化髋臼四方区阻挡钢板可以同时对前柱、四方区和后柱整体进行固定,无需塑形,骨折复位固定效果良好,早期临床疗效满意。Objective To investigate the advantages and disadvantages and clinical effects of integrated acetabular quadrilateral surface buttress plate in the treatment of acetabular both column fractures.Methods From September 2017 to March 2019,14 patients with acetabular both column fractures were treated with integrated quadrilateral acetabular buttress plate and were followed up.The clinical data were retrospectively analyzed.There were 10 males and 4 females with an average age of 53.2 years(range,26-75 years).Fracture classification were both column fractures according to the Letournel-Judet classification system,including 11 cases of combined posterior wall without posterior dislocation.The time from injury to operation was 8-19 days,with an average of 10.3 days.All operations were performed with a supra-ilioinguinal approach.After satisfactory reduction,the integrated acetabular quadrilateral surface buttress plate was used to fix the anterior and posterior column and quadrilateral fractures at the same time.After operation,Matta criteria was used to evaluate the quality of fracture reduction on postoperative images,and modified Merle d'Aubigné-Postel score to evaluate hip joint function.Results The average operation time was 180 min(range,120-320 min),and the intraoperative average blood loss was 980 ml(range,700-1600 ml).Operations were performed successfully with none intraoperative reshaping conducted,and the plate could fit into the bone surface well.All 14 patients were followed up with an average of 15.6 months(range,9-20 months).During the follow-up,all fractures healed with an average of 3 months(range,2.5-5 months).The reduction quality evaluated by the Matta criteria were 7 anatomical,5 satisfactory,and 2 unsatisfactory,with an excellent and good rate of 85.7%(12/14).The hip joint function at the last follow-up was in accordance with the modified Merle d'Aubigné-Postel score was 12-18 points,with an average of 16.9 points,of which 8 excellent,4 good,and 2 fair.The excellent and good function rate was 8

关 键 词：髋臼 骨折 骨折固定术 内 内固定器 

分 类 号：R687.3[医药卫生—骨科学]