弹性钢板在粉碎性髋臼后壁骨折治疗中的应用

Treatment of comminuted posterior acetabular wall fractures with spring plates

目的探讨弹性钢板在粉碎性髋臼后壁骨折治疗中的应用价值。方法回顾性分析2002年2月至2010年2月采用手术治疗的31例粉碎性髋臼后壁骨折患者资料，男22例，女9例；年龄20～55岁，平均31．5岁。受伤至手术时间为1～17d，平均6．7d。手术均采用Kocher—Langenbeck入路，术中尽量保护粉碎骨块上附着的软组织，后壁有压缩者取大转子松质骨填充，尽量使每一粉碎骨折块都达到解剖复位，将1／3管型钢板制成弹性钢板固定，再予重建钢板呈“十”、“廾”或“卅”字形固定。采用改良的Merle d’Aubigne和Postel评分系统评定患髋功能。结果31例患者术后骨折复位质量根据改良的Matta复位标准评定：优24例，良5例，可1例，差1例，优良率为93．5％。23例患者术后获平均2．6年（2～8年）随访。术后1年根据改良的Merle d’Aubigne和Postel评分系统评定患髋功能：优15例，良4例，中3例，差1例，优良率为82．6％。1例患者发生股骨头坏死。4例患者发生异位骨化，其中1例为Brooker分级Ⅲ级，1例为Ⅱ级，2例为Ⅰ级。2例坐骨神经损伤患者术后3个月恢复。4例患者术后3年发生创伤性关节炎。结论对于粉碎性髋臼后壁骨折，弹性钢板能提供稳定可靠的固定，且能满足早期功能锻炼的要求，具有一定的应用价值。

Objective To report our experience of treating comminuted posterior acetabular wall fractures with spring plates. Methods We reviewed 31 patients who had received open reduction and internal fixation with spring plates for comminuted posterior acetabular wall fractures from February 2002 to Febnlary 2010 in our department. They were 22 males and 9 females with a mean age of 31.5 years （range, 20 to 55 years）. The mean time form injury to operation was 6. 7 days （range, 1 to 17 days）. The operations were performed through the Kocher-Langenbeck approach with the patients in tile lying position on the uninjured side. The soft tissues that attached to the fragments were carefully preserved. The depressed defects of the posterior aeetabular wall were filled with the cancellous bone from the greater trochanter. Fragments were reduced one by one and buttressed with a spring plate （made from 1/3 tubular plate） before final cross fixation with a reconstruction plate. The functional outcomes were evaluated by the modified Merled＇ Aubigne and Postel＇ clinical grading system. The radiographs were graded according to the Matta/Judet criteria. Results By the Matta/Judet criteria, 24 cases achieved excellent reduction, 5 good reduction, one fair reduction and one poor redaction, with a good to excellent rate of 93.5%. Of this series, 23 patients were followed up for 2.6 years on average （range, 2 to 8 years）. By the modified Merled＇Aubigne and Postel＇ criteria, functional recovery of the affected hip one year postoperation was rated as excellent in 15 cases, good in 4 cases, fair in 3 cases and poor in one case, with a good to excellent rate of 82.6%. Femoral head necrosis occurred in one patient and heterotopic ossification in 4 patients. By Brooker classification, the heterotopic ossification was rated as degree Ⅲ in one patient, degree Ⅱ in one patient and degree Ⅰ in 2 patients, Two patients with injury to the sciatic nerve recovered 3 months postoperatinn. Traumatic arthritis happened in 4 patients 3 years postoperation. Conclusion Spring plates can be used to treat comminuted posterior acetabular wall fractures, because they can provide stable fixation and allow for early functional exercise.