锁定加压重建钢板在髋臼骨折中的应用

The application of locking-compression reconstruction plate in the surgical treatment of acetabular fractures

目的探讨锁定加压重建钢板（重建LCP）治疗髋臼骨折的优点及应用原则。方法27例复杂髋臼骨折采用锁定加压重建钢板内固定，骨折按照Letounel分类，后柱合并后壁骨折5例，横形合并后壁骨折4例，双柱骨折11例，前柱合并后半横形骨折7例。Kocher—Langenbeck人路9例，Kocher—Langenbeck人路联合髂腹股沟人路18例。结果27例中有24例获得随访，随访时间8～29个月（平均21个月），复位质量按照Matta评分，优13例，良9例，可2例；髋关节功能按Harris评分，优15例，良8例，可1例。术后发生骨关节炎1例，无感染、坐骨神经损伤、静脉血栓、异位骨化和股骨头缺血等并发症。结论锁定加压重建钢板具有对松质骨良好的把持力、锁定后的角稳定性、无需钢板帖服以及单皮质螺钉可以防止螺钉进入关节腔等优点，是治疗髋臼骨折比较理想的内固定材料，使用应遵循先加压后锁定、长钢板少螺钉的原则。

Objective To investigate the advantage and principle of locking-compression reconstruction plate in the treatment of acetabular fractures. Methods 27 cases of displaced acetabular fractures were treated by open reduction and internal fixation with locking-compression reconstruction plates. This series included 5 cases of posterior column and wall fractures ,4 case of transverse and posterior wall fractures,7 cases of anterior and hemitransverse fractures and 11 cases of both column fractures according to the Letounel classification. Kocher-Langenbeck approach was used in 9 cases, Kocher-Langenbeck approach combined with ilio-inguinal approach in 18 cases. Results 24 patients were followed up for 8 to 29 months （ average 21 months）. Evaluation of reduction by Matta scoring system revealed excellent in 13 cases, good in 9 and moderate in 2. According to Harris scoring system, the hip function was excellent in 15 cases, good in 8 and moderate in 1. Complications such as deep infection, nerve injury, deep venous thrombosis, heterotopic ossification, osteoarthritis and avascular necrosis of the femoral head were not found. Conclusion Locking-compression reconstruction plate is an ideal implant for internal fixation as it provides good purchase to cancellous bone, angular stability after locking, no need of plate contour and prevents screws from penetrating the hip joint when unicortical screws are used. However the principle should be followed to perform compression before locking and to use longer plate with fewer screws.