前路接骨板联合单枚和多枚后柱螺钉治疗髋臼双柱骨折的疗效比较  

Comparison Plates With Single and Multiple Posterior Column Screw through Anterior Approach in the Treatment of Both Columns Acetabular Fractures

作　　者：王朝晖 曹书杰 刘建伟 赵快平 唐艳平 张亮 Wang Zhaohui;Cao Shujie;Liu Jianwei;Zhao Kuaiping;Tang Yanping;Zhang Liang(Department of Orthopaedic Trauma,the Affiliated Chenzhou Hospital,Hengyang Medical School,University of South China,Chenzhou 423000,China)

机构地区：[1]南华大学衡阳医学院附属郴州医院创伤骨科,湖南郴州423000

出　　处：《实用骨科杂志》2023年第8期673-678,共6页Journal of Practical Orthopaedics

基　　金：湖南省卫生健康委科研项目(202104070593)。

摘　　要：目的观察比较前入路预塑形接骨板联合单枚和多枚后柱螺钉治疗髋臼双柱骨折的临床疗效。方法回顾性分析比较2016年1月至2022年6月南华大学衡阳医学院附属郴州医院采用前入路预塑形接骨板联合单枚和多枚后柱螺钉治疗的33例髋臼双柱骨折患者,男23例,女10例;年龄18~72岁,平均(49.8±14.2)岁。术前利用3D打印骨盆模型预塑形接骨板。单枚后柱螺钉固定组14例,多枚后柱螺钉组19例。采用Matta标准评估髋臼骨折复位质量,采用改良的Merle D’Aubigne和Postel评分系统评估髋关节功能。结果所有患者均获随访,随访时间8~34个月,平均(10.3±4.5)个月。骨折均愈合。多枚后柱螺钉组手术时间、术中出血量、透视时间显著高于单枚后柱螺钉组(P<0.05),两组间骨折愈合时间比较,差异无统计学意义(P>0.05)。术后骨折复位质量:单枚后柱螺钉组优3例,良9例,差2例,优良率85.7%;多枚后柱螺钉组优13例,良5例,差1例,优良率94.7%;两组优良率比较差异无统计学意义(P>0.05),但多枚后柱螺钉组解剖复位率明显高于单枚后柱螺钉组,差异有统计学意义(P<0.05)。髋关节功能评估:单枚后柱螺钉组优4例,良8例,可2例,优良率85.7%;多枚后柱螺钉组优7例,良9例,可3例,优良率84.2%,两组优良率比较差异无统计学意义(P>0.05)。结论前入路预塑形接骨板联合单枚和多枚后柱螺钉治疗髋臼双柱骨折均可获得满意疗效,多枚后柱螺钉具有更好的复位固定作用。Objective To compare the clinical results of pre-contoured plates combined with single and multiple antegrade posterior column screw via anterior approach for treatment of both columns acetabular fractures.Methods A retrospective analysis was performed on 33 patients with both columns acetabular fractures treated with pre-contoured plates combine single and multiple antegrade posterior column screw via anterior approach from Jan 2016 to Jun 2022.There were 23 males and 10 females,with an average of(49.8±14.2)years(range,18 to 72 years).Preoperative 3D printing of pelvic model and pre-contoured plates were applied.There were 14 cases in simple posterior column screw group and 19 cases in multiple posterior column screws group.The fracture reduction was assessed with Matta scoring system,and the hip function was evaluated with modified Merle D’Aubigne and Postel scoring system.Results All cases were followed up for 8 to 34 months with an average of(10.3±4.5)months.The acetabular fractures all healed.The operation time,intraoperative blood loss and fluoroscopy time in multiple posterior column screws group were significantly higher than simple posterior column screw group(P<0.05).No significant difference was found in fracture site healing time between the two groups(P>0.05).Fracture reduction quality was excellent in 3 cases,good in 9 cases,pool in 2 cases,the excellent and good rate was 85.7%in simple posterior column screw group,and it was excellent in 13 cases,good in 5 cases,poor in 1 case,the excellent and good rate was 94.7%in multiple posterior column screw group.No significant difference was found between the excellent and good rate of fracture reduction(P>0.05),but the rate of anatomical reduction in multiple posterior column screw group was significantly higher than simple posterior column screw group(P<0.05).The hip function was excellent in 4 cases,good in 8 cases,fair in 2 cases,the excellent and good rate was 85.7%in simple posterior column screw group,and excellent in 7 cases,good in 9 cases,fair

关 键 词：髋臼双柱骨折 后柱螺钉 手术入路 

分 类 号：R683.3[医药卫生—骨科学]