髋臼上方水平钢板结合排筏螺钉内固定治疗合并臼顶压缩老年髋臼骨折的疗效  

Efficacy of horizontal plate plus raft screws above the acetabulum in the treatment of acetabular fractures combined with dome impaction in the aged patients

作　　者：刘兆杰[1] 贾健[1] 戚浩天 孙玉玺 李刚[1] 田维[1] 王宏川[1] 白树财 李鹏飞[1] Liu Zhaojie;Jia Jian;Qi Haotian;Sun Yuxi;Li Gang;Tian Wei;Wang Hongchuan;Bai Shucai;Li Pengfei(Department of Traumatic Orthopedics,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院创伤骨科,天津300211

出　　处：《中华创伤杂志》2024年第3期221-228,共8页Chinese Journal of Trauma

摘　　要：目的比较髋臼上方水平钢板结合排筏螺钉与单纯螺钉内固定治疗合并臼顶压缩老年髋臼骨折的疗效。方法采用回顾性队列研究分析2013年5月至2023年1月天津市天津医院收治的20例合并臼顶压缩老年髋臼骨折患者的临床资料,其中男5例,女15例;年龄61~84岁[(72.2±7.3)岁]。根据Letournel&Judet分型:前柱骨折13例,前柱伴后方横行骨折5例,双柱骨折2例。患者均行前方入路切开复位内固定治疗,其中11例采用髋臼上方水平钢板结合排筏螺钉固定(钢板+排筏螺钉组),9例采用单纯螺钉固定(单纯螺钉组)。比较两组手术时间、术中出血量、术中透视次数;术后3 d采用Matta影像学标准评估骨折复位质量;术后3个月及末次随访时采用Merle D′Aubigné‑Postel评分系统评价患侧髋关节功能并比较末次随访时优良率;观察术后并发症发生情况。结果患者均获随访6~18个月[(13.1±3.1)个月]。两组手术时间、术中出血量及术中透视次数比较,差异均无统计学意义(P>0.05)。术后3 d Matta影像学标准:钢板+排筏螺钉组解剖复位6例,满意复位5例,单纯螺钉组分别为5例和4例(P>0.05)。术后3个月及末次随访时,钢板+排筏螺钉组Merle D′Aubigné‑Postel评分分别为(14.0±2.4)分、(15.8±2.2)分,均高于单纯螺钉组的(11.0±2.6)分、(13.0±3.1)分(P<0.01),且两组末次随访时均较术后3个月进一步提高(P<0.01)。末次随访时,钢板+排筏螺钉组Merle D′Aubigné‑Postel评分优3例,良6例,可1例,差1例,优良率为81.8%;单纯螺钉组良3例,可2例,差4例,优良率为33.3%(P<0.05)。钢板+排筏螺钉组1例、单纯螺钉组5例术后出现臼顶压缩骨折再移位且并发创伤性髋关节炎(P<0.05)。结论对于合并臼顶压缩的老年髋臼骨折,髋臼上方水平钢板结合排筏样螺钉较单纯螺钉内固定治疗可有效促进髋关节功能恢复、减少术后臼顶压缩骨折再移位及创伤性关节炎的发生。Objective To compare the efficacy of the horizontal plate plus raft screws above the acetabulum and fixation with screws only for acetabular fractures combined with dome impaction in the aged patients.Methods A retrospective cohort study was conducted to analyze the clinical data of 20 aged patients with acetabular fractures combined with dome impaction,who were admitted to Tianjin hospital between May 2013 and January 2023,including 5 males and 15 females,aged 61‑84 years[(72.2±7.3)years].According to Letournel and Judet classification,13 patients had anterior column fracture,5 anterior column fracture combined with posterior transverse fracture and 2 two‑column fracture.All the patients underwent open reduction and internal fixation through an anterior approach.Of them,11 patients were treated with the fixation with the horizonal plate plus raft screws above the acetabulum(plate plus raft screw group)and 9 with the screws only(screw only group).The operative time,intraoperative blood loss,and intraoperative fluoroscopy times were compared between the two groups.The quality of fracture reduction was evaluated with the Matta′s radiographic criteria at 3 days after surgery and the function of the hip joint was assessed with Merle D′Aubignéand Postel scoring system at 3 months after surgery and at the last follow‑up as well as the excellent and good rate at te last follow-up.The occurrence of postoperative complications was observed.Results All the patients were followed up for 6‑18 months[(13.1±3.1)months].There were no significant differences in the operative time,intraoperative blood loss or intraoperative fluoroscopy times between the two groups(P>0.05).According to the Matta′s radiographic criteria at 3 days after surgery,patients with anatomical reduction and satisfactory reduction accounted 6 and 5 in the plate plus raft screw group,compared to 5 and 4 respectively in the screw only group(P>0.05).The values of Merle D′Aubignéand Postel score at 3 months after surgery and at the last follo

关 键 词：髋臼 骨折 压缩性 老年人 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]