重建钢板联合记忆合金骑缝钉治疗髋臼骨折

Treatment of acetabular fractures with pelvic reconstruction plates and shape memory alloy staples

目的 探讨重建钢板联合记忆合金骑缝钉治疗髋臼骨折的可行性及临床效果。方法 对2003年5月～2004年12月收治的17例髋臼骨折患者按照Letoumel分类：T形骨折2例，后柱骨折3例，后柱并后壁骨折2例，后壁并横行骨折2例，前柱骨折1例，前柱并横行骨折2例，双柱骨折2例，双柱及前后壁骨折3例。根据骨折类型分别采用单一或联合髂腹股沟入路、髋臼后侧入路，行重建钢板联合记忆合金骑缝钉内固定治疗。结果 本组患者骨折复位质量按照Matta的评分标准，16例达到解剖复位，1例复位欠佳。所有患者获得9～21个月（平均13个月）随访，采用Modified d’Aubigne and Postal功能评定标准：优14例，良2例，可1例，优良率为94．1％；本组有1例发生创伤性关节炎，未见异位骨化发生。结论 术前骨折分类的明确、合适入路的选择、满意的解剖复位及可靠的内固定是治疗髋臼骨折的关键，采用重建钢板联合记忆合金骑缝钉的内固定方式是一种有效的治疗方法。

Objective To discuss the feasibility and clinical effects of pelvic reconstruction plates and shape memory alloy staples in treatment of complex acetabular fractures. Methods From May 2003 to December 2004, 17 patients with acetabular fractures were treated with pelvic reconstruction plates and shape memory alloy staples. There were 11 males and 6 females, with an average age of 31.8 years ranging from 21 to 58 years. The preoperative diagnosis of the patients revealed T-shaped fractures in 2, posterior column fractures in 3, posterior column and wall fractures in 2, transverse and posterior wall fractures in 2, anterior column fracture in 1, anterior column and transverse fractures in 2, double column fractures in 2, double column and double wall fractures in 3, according to Letournel＇s classification. Single or combined ilioinguinal, or Kocher-Langeubeck approaches were adopted, depending on the fracture classification of the 17 patients. Results By Matta criteria, 16 patients got anatomic reduction and 1 got unsatisfactory reduction. All the patients were followed up for 6 to 18 months, averaging 13 months. Based on Modified d＇ Aubigne and Postel evaluation system, 14 patients achieved excellent results, 2 good, and 1 fair. The rate of good to excellent results was 94. 1%. Traumatic arthritis occurred in 1 patient and none heterotopic ossification occurred. Conclusion Internal fixation with pelvic reconstruction plates and shape memory alloy staples is an effective way to treat complex acetabular fractures.