髋臼记忆合金三维内固定系统治疗涉及臼顶负重关节面的髋臼骨折

A shape-memory alloy internal fixator for treatment of acetabular fractures involving weight-bearing area

目的探讨髋臼记忆合金三维内固定系统（ATMFS）治疗涉及臼顶负重关节面髋臼骨折的临床疗效。方法2003年8月至2009年2月共收治28例涉及臼顶负重关节面的髋臼骨折患者，男19例，女9例；年龄18～70岁，平均39．2岁。伤后3周内（3～15d）手术的新鲜骨折24例，超过3周（29～58d）的陈旧性骨折4例。髋臼骨折根据Letournel＆Judet分型：后壁骨折17例，后柱骨折5例，横形骨折5例，T形骨折1例。根据张春才等的髋臼三柱浮动分类法分型：28例均为涉及中柱壁的骨折，其中Aml型19例，Am2型6例，Am3型3例。所有患者均采用改良髋关节后外侧人路ATMFS治疗。结果28例患者术后获6～30个月（平均8．5个月）随访。术中直视下骨折复位情况根据Matta标准评定：解剖复位25例（89．3％），满意复位3例（10．7％）。术后摄X线片复查未发现骨折再移位。28例于术后11．1～15．0周（平均12．7周）获骨性愈合，患侧髋关节功能达到健侧水平。按照改良Aubigne＆Postal临床分级标准评定疗效：优18例，良8例，可2例，优良率为92．9％。结论ATMFS是治疗涉及臼顶负重关节面髋臼骨折的有效方法，其合理的设计更贴服于臼顶不规则解剖结构，持续应力加压作用可促进骨折愈合，多点多维锁定固定方式为局部植骨或重建提供了空间。

Objective To assess the mid-term results of acetabular three-dimensional memory fixation system （ATMFS） used to reconstruct weight-hearing area of the aeetabulum. Methods From August 2003 to February 2009, totally 28 eonsecutive cases of unilateral severe fracture of the weight-bearing area of the posterior aeetabular wall were treated with open reduction and ATMFS in our department. They wel~ 19 males and 9 females, with a mean age of 39.2 years （range, 18 to 70 years）. Four fractures were old and 24 fresh. Aceording to the Letournel ＆ Judet classification system, there were 17 posterior wall fractures, 5 posterior colunm fractures, 5 transverse fl＇aetures, and one T-shaped fracture. According to the Zhang Chun-cai＇s classification system, the 28 eases all belonged to middle column-wall fracture, of which 19 were type Aml, 6 type Am2 and 3 type Am3. A modified hip posterolateral approach was adopted for all the patients. Results The 28 patients were followed up from 6 to 30 months （average, 8.5 months）. None of the patients lost reduction after surgery, and there was no case of implant failure. By Matta＇s criteria, 25 cases aehieved anatomical reduction （89.3%） and 3 satisfactory reduction （10. 7% ） . All the patients achieved bony union in an average time of 12.7 weeks ＇after operation （from 11. 1 to 15.0 weeks） . At the final follow-up, according to D＇ Aubigne ＆ Postal＇s criteria, 92.9% of the patients were rated as excellent or good. Conclusions ATMFS, as a wise biomechanical method to treat fractures involving weight-bearing area of the aeetabulum, ensures stahility of the hip joint, consistent compressive stress which promotes fracture union, and convenience of local grafting and reconstruction. It is an effective internal fixator for treatment of acetabular fractures involving welght-bearing area.