髋臼镍钛记忆合金三维内固定系统治疗陈旧性髋臼后壁骨折合并骨缺损

APPLICATION OF ACETABULAR TRIDIMENSIONAL MEMORY ALLOY-FIXATION SYSTEM IN TREATMENT OF OLD ACETABULAR POSTERIOR WALL FRACTURE WITH BONE DEFECT

目的探讨应用髋臼镍钛记忆合金三维内固定系统(acetabular tridimensional memory alloy-fixationsystem,ATMFS)结合自体髂骨解剖重建髋臼后壁骨折合并骨缺损的临床效果。方法 2002年1月-2009年2月,收治17例陈旧性髋臼后壁骨折合并骨缺损患者。男11例,女6例;年龄20～60岁,平均41.7岁。骨折至该次入院时间为14～180 d,平均63 d。髋臼关节面移位均≥3 mm。骨缺损按照美国骨科医师协会(AAOS)髋臼骨折缺损分型标准:Ⅰ型4例,Ⅱ型6例,Ⅲ型5例,Ⅳ型2例。手术去除残留的髋臼后壁骨折块和增生软组织,复位股骨头后取自体游离髂骨植于后壁缺损处,ATMFS固定重建髋臼后壁,加用人工韧带重建髋关节囊韧带,防止股骨头再脱位。结果术后3 d骨折复位按照Matta影像评定标准:优8例,良6例,可2例,差1例,优良率为82.3%。术后切口均Ⅰ期愈合,无坐骨神经损伤发生。患者术后均获随访,随访时间1～8年,平均3.9年。术后2～6个月骨折均愈合,平均3.6个月。术后1例发生股骨头缺血性坏死,1例发生髋臼周围异位骨化。术后1年,患者髋关节功能按照Merle d’Aubigné-Postel的评分系统评价:获优9例,良6例,可1例,差1例,优良率为88.2%。结论 ATMFS结合自体髂骨游离移植,利用人工韧带重建髋关节囊韧带,是治疗髋臼后壁陈旧性骨折合并骨缺损的有效方法,它可以恢复髋关节的后方稳定,防止股骨头再脱位。

Objective To investigate the effectiveness of acetabular tridimensional memory alloy-fixation system（ATMFS） combined with autologous iliac bone in the treatment of old acetabular posterior wall fracture with bone defect.Methods Between January 2002 and February 2009,17 patients with old acetabular posterior wall fracture and bone defect were treated,including 11 males and 6 females with an average age of 41.7 years（range,20-60 years）.The time from fracture to admission was 14-180 days（mean,63 days）.The displacement of the acetabular articular surface was more than or equal to 3 mm.According to the America Association of Orthopedic Surgeon（AAOS） acetabular fracture and defect classification standard,there were 4 cases of type I,6 cases of type II,5 cases of type III,and 2 cases of type IV.After the residual fracture fragments of the acetabular posterior wall and soft tissue hyperplasia were removed,the femoral head was reducted,and posterior wall defect was repaired with autologous iliac bone graft;ATMFS was used to fix acetabular posterior wall and artificial capsular ligament to reconstruct the hip so as to prevent re-dislocation of the femoral head.Results According to Matta imaging assessment standard,the results were excellent in 8 cases,good in 6 cases,fair in 2 cases,and poor in 1 case with an excellent and good rate of 82.3%.All incisions healed by first intention,and no sciatic nerve injury occurred.All patients were followed up 1-8 years（mean,3.9 years）.The mean time of fracture union was 3.6 months（range,2-6 months）.Avascular necrosis of femoral head occurred in 1 case,heterotopic ossification around the acetabulum in 1 case.According to Merle d’Aubigné-Postel scoring system evaluation,the clinical results were excellent in 9 cases,good in 6 cases,fair in 1 case,and poor in 1 case with an excellent and good rate of 88.2%.Conclusion ATMFS combined with autologous iliac bone graft and artificial ligament reconstruction of the hip joint capsule is a good choice for the treatment of old acetabular posterior wall fractures with bone defect,which can resume the posterior hip joint stability and prevent re-dislocation of the femoral head.