两种不同内固定治疗髋臼后壁骨折的早期疗效分析

Comparison of two internal fixations for fractures of posterior acetabular wall

目的 探讨重建钢板与髋臼记忆合金内固定系统（ATMFS）治疗髋臼后壁骨折的早期临床疗效及其差异。方法回顾性分析2001年5月至2007年5月采用重建钢板（重建钢板组，22例）或ATMFS（ATMFS组，19例）治疗且获得随访的41例髋臼后壁骨折患者资料，比较两组的手术操作时间、术中出血量、骨折复位Matta分级、术后6个月及24个月Harris评分等方面的差异。结果41例患者术后获平均24个月（12-43个月）随访。重建钢板组和ATMFS组手术时间分别为（100．83±15．29）、（84．21±11．61）min，差异有统计学意义（t=3．375，P=0．002），术中出血量分别为（1005．56±224．85）、（842．86±142．56）mL，差异有统计学意义（t=2．359，P=0．025）。重建钢板组：解剖复位15例，满意复位5例，不满意复位2例；术后3例发生并发症。ATMFS组：解剖复位13例，满意复位4例，不满意复位2例；术后2例发生并发症。术后6个月和24个月时重建钢板组Harris评分分别为（80．83±10．01）、（91．68±8．56）分（P〈0．05），ATMFS组Harris评分分别为（84．43±10．17）、（92．37±11．03）分，差异有统计学意义（P〈0．05）。在同一时点，两组比较差异均无统计学意义（P〉0．05）。术后24个月时，重建钢板组和ATMFS组的临床结果优良率基本相近，分别为77．27％（17／22）和78．94％（15／19）。结论重建钢板和ATMFS均可以较好地复位和固定髋臼后壁骨折，而使用ATMFS可以明显缩短手术时间、减少术中出血量。

Objective To compare the initial clinical effects of the pelvic reconstructive plate （PRP） and the acetabular tridimensional memory alloy fixation system （ATMFS） in the treatment of fractures of posterior acetabular wall. Methods A retrospective analysis was done on 41 patients who had been treated for fractures of posterior acetabular wall from May 2001 to May 2007 and whose follow-up records were complete. Of them, 22 cases underwent PRP fixation and 19 ATMFS fixation. The quality of reduction （Matta grading）, function assessment （Harris grading）, operative time and intraoperative blood loss were compared between the 2 groups. Results The average follow-up period was 24 （12 to 43） months. For PRP and ATMFS groups, the operative time was 100.83±15.29 and 84.21±11.61 minutes （t=3.375, P= 0. 002）, and the blood loss was 1005.56 ± 224.85 mL and 842.86 ± 142. 56 mL （ t = 2. 359, P = 0. 025） respectively. In the PRP group, 20 cases obtained anatomical and satisfactory reduction while in the other group, 17 cases did. Both groups had 2 cases of unsatisfactory reduction. At post-operative 6 months and 24 months, the Harris scores were 80. 83±10.01 and 91.68 ± 8.56（ P 〈 0.05） respectively in the PRP group, while those were 84.43 ± 10. 17 and 92. 37 ± 11.03 （ P 〈 0. 05 ） respectively in the ATMFS group. There was no significant difference between the 2 groups at the same time points （ P 〉 0.05）. At post-operation 24 months, the good to excellent rates of therapeutic results were 77.27% （17/22） in the PRP group and 78.94 （15/19） in the ATMFS group, without significant difference. Conclusions Both PRP and ATMFS may be an appropriate and effective fixation for fractures of posterior acetabular wall. ATMFS can have advantages of shorter operative time and less intraoperative blood loss.