导航下经皮顺行前柱螺钉联合后路接骨板内固定治疗髋臼横行伴后壁骨折的疗效观察  

Navigation-assisted percutaneous anterior column screws and posterior plates for the treatment of associated transverse and posterior wall fractures of the acetabulum

作　　者：方志勋 钱胜龙 汪国栋 裴璇 柯烯 刘曦明 Fang Zhixun;Qian Shenglong;Wang Guodong;Pei Xuan;Ke Xi;Liu Ximing(Department of Orthopedics,General Hospital of Central Theater Command,Wuhan 430070,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]中部战区总医院骨科,武汉430070 [2]南方医科大学第一临床医学院,广州510515

出　　处：《创伤外科杂志》2024年第5期370-376,共7页Journal of Traumatic Surgery

基　　金：卫勤保障能力创新与生成专项(20WQ034);2021年度湖北省卫健委首届转化医学(WJ2021ZH0010)。

摘　　要：目的比较导航下经皮顺行前柱螺钉联合后路重建钢板与单纯后路重建钢板内固定治疗髋臼横行伴后壁骨折的临床疗效。方法采用回顾性队列研究分析2012年1月—2022年1月中部战区总医院骨科收治的36例髋臼横行伴后壁骨折患者的临床资料,男性22例,女性14例;年龄25~69岁,平均44.9岁;道路交通伤25例,高处坠落伤8例,挤压伤3例。按照手术方式不同分为联合固定组(19例)和单纯后路组(17例),联合固定组使用导航下经皮前柱螺钉联合后路重建钢板内固定治疗,单纯后路组使用单纯后路重建钢板内固定治疗。比较两组手术时间、术中出血量、骨折愈合时间及完全负重时间。术后2 d采用Matta影像学评估标准评价骨折复位质量。术后3、6个月及末次随访时采用改良Merle d’Aubigné-Postel评分标准评估患侧髋关节功能。观察术后并发症发生情况。结果两组均获随访12~44个月,平均22.1个月。联合固定组手术时间(136.4±8.7)min显著长于单纯后路组(96.2±13.5)min,骨折愈合时间(12.7±2.5)周显著短于单纯后路组(14.9±2.4)周,完全负重时间(17.4±2.8)周显著短于单纯后路组(20.0±3.9)周,差异均有统计学意义(P<0.05)。两组术中出血量比较差异无统计学意义(P>0.05)。术后2 d根据Matta影像评分,联合固定组解剖复位16例,不完全复位3例,解剖复位率为84.2%;单纯后路组解剖复位13例,不完全复位3例,不满意复位1例,解剖复位率为76.5%,两组患者Matta影像学评价比较差异无统计学意义(P>0.05)。术后3、6个月改良Merle d’Aubigné-Postel评分显示联合固定组患侧髋关节功能显著优于单纯后路组(P均<0.05);而末次随访时,两组患者患侧髋关节功能评分比较差异无统计学意义(P>0.05)。联合固定组术后并发症发生率为21.1%(4/19),单纯后路组为23.5%(4/17),差异无统计学意义(P=0.858)。结论使用后路重建钢板联合经皮顺行前柱螺钉治疗髋臼Objective To investigate the clinical outcome of navigation-assisted percutaneous anterior column screws combined with posterior reconstruction plates versus simple posterior reconstruction plates for the treatment of associated transverse and posterior wall fractures of the acetabulum.Methods A retrospective cohort study was conducted on the data of 36 patients with associated transverse and posterior wall fractures of the acetabulum,who were admitted to the General Hospital of Central Theater Command from Jan.2012 to Jan.2022.There were 22 males and 14 females aged 25-69(44.9)years,with 25 road traffic injuries,8 falls from height and 3 crush injuries.Among them,19 were treated with internal fixation using navigation-assisted percutaneous anterior column screws combined with posterior reconstructive plates and classified into the combined fixation group,while the other 17 cases were treated with posterior reconstruction plates and classified into the simple posterior group.The operation time,intraoperative blood loss and fracture healing time of the two groups were compared.Fracture reduction quality was evaluated using Matta criteria at 2 d postoperatively.The modified Merle d'Aubigné-Postel score was used to evaluate the hip function at 3,6 months and last follow-up.The incidence of postoperative complications was recorded.Results All patients were followed up for 12-44(mean 22.1)months.Compared with the simple posterior group,the combined fixation group showed much longer operation time(min,136.4±8.7 vs.96.2±13.5),but much quicker fracture healing(weeks,12.7±2.5 vs.14.9±2.4)and full weight-bearing(weeks,17.4±2.8 vs.20.0±3.9,all P<0.05).The intraoperative blood loss showed no significant significance between the two groups(P>0.05).At postoperative 2 d,the Matta criteria showed that the anatomical reduction was 84.2%(16/19)in the combined fixation group with 3 cases of incomplete reduction and 76.5%(13/17)in the simple posterior group,with 3 cases of incomplete and 1 unsatisfied reduction,revealing no s

关 键 词：髋臼骨折 骨折固定术 钢板 导航系统 

分 类 号：R683.3[医药卫生—骨科学]