双尖钢板技术治疗髋臼后壁骨折

Usage of double fork plates in the treatment of ture of the acetabulum

目的探讨双尖钢板在治疗髋臼后壁骨折中的应用价值。方法回顾性分析2008年7月-2012年7月应用双尖钢板技术治疗的11例髋臼后壁骨折，其中男8例，女3例，年龄22～53岁，平均35．3岁，受伤至手术时间为1～19d，平均7．8d。所有患者均采取Kocher-langenbeck入路，取A01／3管型钢板制成双尖钢板，结合重建钢板固定后壁骨折块。术后采用Matta复位标准评价骨折复位情况，采用改良Merled’Aubigne和Postel标准评定髋关节功能。结果本组11例患者获得平均25个月（12～33个月）门诊或电话随访。末次随访时骨折复位质量：优7例，良3例，可1例，差0例，优良率90．9％；根据Merled’Aubig—Be和Postel评分标准评定患者疗效：优6例，良3例，可2例，差0例，优良率81．8％。其中术后1例患者发生异位骨化；无感染、无股骨头缺血性坏死、无创份性关节炎等并发症的发生。结论对于髋臼后壁存在无法用螺钉固定的骨折块或存在臼缘小型骨折块时，双尖钢板结合重建钢板可以提供坚强、牢靠的固定，术后患者功能恢复好，是一项有效的固定方式。

Objective To explore the efficacy of double fork plate in treating the posterior wall fracture of the acetabulum. Methods Reviewed 11 patients who had treated with open reduction and internal fixation with double fork plates for posterior wall fracture of the acetabulum from July 2008 to July 2012, including 8 male cases and 3 female cases with an average age of 35.3 years（ from 22 to 53 years）. The average time from getting injury to opera- tion was 7.8 days（from 1 to 19 days）. The operations were performed through the Kocher-langenbeck approach. Double fork plates （ formed from a three- or four- tubular plate） with an overlapping reconstruction plate used for pos- terior wall fragments. The functional outcomes were evaluated by the modified Merled＇Aubigne and Postel＇clinical garding system. The radiographs were graded according to the Matte criteria. Results The patients were adopted telephone or outpatient follow-up for 25 months on average（from 12 to 33 months）. By the Matte criteria, 7 cases achieved excellent reduction, 3 good reduction, 1 case fair reduction and none poor reduction, with the good and ex- cellent rate of 90.9%. By the modified Merled＇Aubigne and Postel＇critria, functional recovery of the affected hip at the last followe-up was rated as excellent in 6 cases, good in 3 cases, fair in 2 cases and none poet,with the good and excellent rate of 81.8%. Heterotopic ossification was happened to 1 patient. Neither infection nor ischemic nec- rosis of the femoral head was recorded. Coclusion Double fork plates with an overlapping reconstruction plate can provid stable fixation and allow for early functional exercise. So the use of Double fork plates have a certain clinical value.