真骨盆缘完整的髋臼高位前柱骨折的治疗

The characteristic and treatment of high anterior column fracture of acetabulum with intact true pelvic brim

目的探讨真骨盆缘完整的髋臼高位前柱骨折的治疗方法。方法2006年1月至2010年1月，治疗12例真骨盆缘完整的髋臼高位前柱骨折，男8例，女4例；年龄29-46岁，平均35．6岁；挤压伤7例，压砸伤3例，高处坠落伤2例。术前常规摄骨盆正位、闭孔斜位、髂骨斜位X线片及CT扫描。根据是否合并后壁骨折及髂骨骨折块的完整性分为单纯型5例，合并后壁型6例，粉碎型1例。5例单纯型及2例合并较小的无移位后壁型骨折者采用髂股入路行髂嵴支持钢板加髂骨前缘拉力螺钉固定；4例合并明显移位的后壁型骨折者采用前后联合入路行拉力螺钉、支持钢板固定；1例粉碎型骨折采用扩展髂股人路行钢板螺钉固定。结果12例患者均获得随访，随访时间14-37个月，平均26．7个月。术后按Matta影像学评定标准，优8例，良3例，差1；优良率为92％。无一例发生骨折不愈合及内固定断裂。末次随访按Matta改良的Meded’Aubigne和Postel功能评分系统评分为11-18分，平均16．8分；优7例，良4例，差1例；优良率为92％。1例发生异位骨化和轻度的创伤性关节炎。结论选择合理的手术人路、解剖复位、坚强固定是治疗真骨盆缘完整的髋臼高位前柱骨折的关键。

Objective To investigate the results of open reduction with internal fixation for high anterior column fracture of acetabulum with intact true pelvic brim. Methods From January 2006 to January 2010, 12 patients suffered high anterior column fracture of acetabulum without involvement of true pelvic brim were identified. There were 9 males and 3 females, with the average of 35.6 years （range, 29-46）. The injury was caused by crush in 7 cases, smash of heavy object in 3 cases, and fall-down from height in 2 cases. These fractures were classified into three types： isolated high anterior column fracture of acetabulum without involvement of true pelvic brim, high anterior column fracture of acetabulum without involvement of true pelvic brim with posterior wall fracture of acetabulum and commminuted high anterior column fracture of acetabulum without involvement of true pelvic brim according to present and unpresent of posterior wall fracture. Five cases suffered isolated fracture and 2 cases associated smaller and nondisplacement fracture fragment of posterior wall were reduced and fixed by buttress plate of iliac crest and lag screw of anterior border of ilium through an iliofemoral approach; 4 cases with displacement posterior wall fracture of acetabulum were reduced and reconstructed by buttress plate and lag screws of through combinations of anterior and posterior approach- es. One case suffered comminuted fracture were reduced and reconstructed by plates and screws of through extended iliofemoral approach. Results The mean follow-up time of all patients was 26.7 months （range, 14-37 months）. The quality of reduction was grade as anatomical in 8 patients, imperfect in 3, poor in 1 by Matta＇s score system. The fracture union was uneventful. There was nonunion and loss of internal fixation. At the final follow-up, the mean score was 16.8 （range, 11-18）, 7 cases were graded as excellent, 4 good, 1 fair, according to modified Merle d＇Aubigne and Postel score system. Heterotopic ossification and traumatic osteoarthritis were recorded in 1 patient. Conclusion Good clinical results can be achieved by anatomical reduction and rigid fixation through optimal approach.