髋臼骨折后方内固定术后创伤性关节炎患者的内植物分析  

Implant analysis of patients with traumatic arthritis after posterior internal fixation of acetabular fractures

作　　者：李明 冯乐玲 肖靖炜 廖奇 郭晓东[3] 侯志勇[4] 陈华[5] 凌晶 吕刚[6] 方跃[7] 庄岩[8] 樊仕才 陆志剀 徐丁 LI Ming;FENG Leling;XIAO Jingwei;LIAO Qi;GUO Xiaodong;HOU Zhiyong;CHEN Hua;LING Jing;LYU Gang;FANG Yue;ZHUANG Yan;FAN Shicai;LU Zhikai;XU Ding(Department of Orthopaedic Trauma,Ningbo No.6 Hospital Affiliated to Ningbo University Medical College,Ningbo 315040,Zhejiang;Health Science Center,Ningbo University,Ningbo 315211,Zhejiang;Department of Orthopaedic Trauma,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022;Department of Orthopaedics,The Third Hospital of Hebei Medical University,Shijiazhuang 050051;Department of Traumatology,The Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,Zhejiang;Department of Orthopaedics,The Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University,Urumqi 830099;Department of Orthopaedics,West China Hospital of Sichuan University,Chengdu 610041;Department of Orthopaedic Trauma,Xi'an Honghui Hospital,Xi'an Jiaotong University College of Medicine,Xi'an 710054;Department of Orthopaedic Trauma,The Third Hospital Affiliated to Southern Medical University,Guangzhou 510630;Department of Orthopaedics,No.906 Hospital of Joint Logistic Support Force of PLA,Ningbo 315000,Zhejiang,China)

机构地区：[1]宁波大学医学院附属宁波市第六医院创伤骨科中心,浙江宁波315040 [2]宁波大学医学部,浙江宁波315211 [3]华中科技大学同济医学院附属协和医院创伤骨科,武汉430022 [4]河北医科大学第三医院骨科,石家庄050051 [5]温州医科大学附属第二医院创伤骨科,浙江温州325027 [6]新疆医科大学附属中医医院骨外科,乌鲁木齐830099 [7]四川大学华西医院骨外科,成都610041 [8]西安交通大学医学院附属红会医院陕西省骨科医院创伤骨科,西安710054 [9]南方医科大学第三附属医院广东省骨科医院创伤骨科,广州510630 [10]解放军联勤保障部队第九〇六医院骨外科,浙江宁波315000

出　　处：《中华骨与关节外科杂志》2023年第6期513-522,共10页Chinese Journal of Bone and Joint Surgery

基　　金：浙江省医药卫生科技计划项目(2018PY059);宁波市鄞州区科技惠民项目(2017YZQ102)。

摘　　要：目的:从内植物技术角度剖析髋臼骨折后方接骨板内固定手术的失败原因及解决方法。方法:回顾性分析2011年1月至2021年12月,从国内10家医院收集的行全髋关节置换术(THA)治疗的髋臼骨折后方接骨板内固定术后创伤性关节炎患者的临床资料。男24例,女3例;年龄37~62岁,平均(49.5±1.2)岁。内固定手术至THA的时间为8~42个月,中位数18.0(16.9,18.3)个月。调阅患者的住院病历、THA手术前后的X线和CT检查资料,从内植物并发症、髋关节骨结构损伤两个层面进行分析。结果:左侧固定77.8%(21例),右侧固定22.2%(6例)。1块重建接骨板固定40.7%(11例)、2块重建接骨板固定55.6%(15例)、4块重建接骨板固定3.7%(1例);螺钉固定数量每例4~15枚。内植物并发症:内植物侵蚀股骨头33.3%(9例)>螺钉滑脱11.1%(3例)>螺钉断裂3.7%(1例)。骨结构损伤:股骨头骨缺损96.3%(26例)>负重区关节面塌陷+后壁骨吸收/坏死77.8%(21例)>股骨头脱位70.4%(19例)>负重区关节面塌陷63.0%(17例)>后壁外缘骨块吸收/坏死55.6%(15例)>关节内骨赘增生11.1%(3例)>髋臼硬化7.4%(2例)、囊性变7.4%(2例)。未有效固定部位:负重区+后壁70.4%(19例)>负重区63.0%(17例)>后壁55.6%(15例)>后柱7.4%(2例)。结论:负重区+后壁关节面骨块未有效固定是导致后方内植物失败的关键因素,内植物失败并发症和骨结构损伤与接骨板螺钉分布直接相关。Objective:To analyze the causes of the failure of posterior plate fixation for acetabular fractures and find the solutions from the perspective of implant technology.Methods:A retrospective analysis was conducted on clinical data of patients with traumatic arthritis after posterior fixation of acetabular fractures treated by total hip arthroplasty(THA)between January 2011 and December 2021 at 10 hospitals.There were 24 males and 3 females,who were 37-62 years old with a mean age of(49.5±1.2)years.The time from internal fixation surgery to THA ranged from 8 to 42 months,with a median time of 18.0(16.9,18.3)months.The patients'medical records,X-ray and CT examination data before and after THA were reviewed,and the analysis was conducted from the two levels of implant complications and hip joint bone damage.Results:There were 77.8%(21 cases)of left-side fixation and 22.2%(6 cases)of rightside fixation.The number of reconstructed plates fixed was 1 in 40.7%(11 cases),2 in 55.6%(15 cases),and 4 in 3.7%(1 case);the number of screws fixed was 4-15 per case.Of implant complications,erosion of the femoral head occurred in 33.3%(9 cases)of cases,screw slippage in 11.1%(3 cases)of cases,and screw breakage in 3.7%(1 cases)of cases.Of bone structure damage,femoral head defect occurred in 96.3%(26 cases)of cases,load-bearing collapse and posterior wall absorption/necrosis occurred in 77.8%(21 cases)of cases,femoral head dislocation occurred in 70.4%(19 cases)of cases,load-bearing collapse occurred in 63.0%(17 cases)of cases,posterior wall absorption/necrosis occurred in 55.6%(15 cases)of cases,intra-articular osteophyte occurred in 11.1%(3 cases)of cases,and acetabular sclerosis and cystic changes occurred in 7.4%(2 cases)of cases.Of ineffective fixation sites,load-bearing area and posterior wall were 70.4%(19 cases)of cases,load-bearing area was 63.0%(17 cases)of cases,posterior wall was 55.6%(15 cases)of cases,posterior column was 7.4%(2 cases)of cases.Conclusions:Ineffective fixation of the load-bearing area and posterior

关 键 词：髋臼骨折 内固定 创伤性关节炎 内植物 髋关节 

分 类 号：R683.3[医药卫生—骨科学]