空心拉力螺钉联合重建钢板治疗真骨盆缘完整的髋臼高位前柱骨折

Hollow lag screws combined with reconstruction plates for treatment of high anterior column fracture of the 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采用空心拉力螺钉联合重建钢板固定的疗效.方法 2009年6月-2012年9月收治真骨盆缘完整的髋臼高位前柱骨折6例,其中挤压伤4例,高处坠落伤2例;参照谭国庆等分型：单纯型4例,粉碎型2例.采用髂股入路先行髋臼顶复位空心拉力螺钉固定,后复位、重建钢板固定髂骨翼及髂嵴.结果 6例术后随访12～24个月,平均18个月.所有患者骨折均愈合,愈合时间12 ～ 18周,平均16周.术后按Matta影像学评定标准,优5例,良1例,优良率100％.末次随访时按Matta改良的Merle d＇Aubigne和Postel髋关节功能评分标准,优4例,良2例,优良率100％.术后2例出现股外侧皮神经麻痹,口服神经营养药物2～3个月后均恢复.结论 空心拉力螺钉联合重建钢板治疗真骨盆缘完整的髋臼高位前柱骨折固定可靠,临床疗效满意.

Objective To investigate the clinical effect of high anterior column fracture of the acetabulum with intact true pelvic brim fixed using hollow lag screws plus reconstruction plates.Methods All cases of high anterior column fracture of the acetabulum with intact true pelvic brim treated from June 2009 to September 2012 were included.Crush contributed to injury in 4 cases and high fall to injury in 2 cases.According to Tan Guoqing＇s classification,4 cases were classified as simple type and 2 cases comminuted type.All cases were treated through iliofemoral approach to reduce and fix acetabular roof by hollow lag screws firstly,and then fix iliac wing and iliac crest by reconstruction plates.Results Six cases were followed up for mean 18 months （range,12-24 months）.Fracture healed after mean 16 weeks （range,12-18 weeks）.Radiological results assessed using Matta＇s score system were excellent in 5 cases and good in 1 case with good to excellent rate of 100%.At the final follow-up,Merle d＆#39; Aubigne and Postel hip score was excellent in 4 cases and good in 2 cases with good to excellent rate of 100%.Two cases sustained lateral femoral cutaneous nerve paralysis after operation and recovered by oral neurotrophic drugs for 2 to 3 months.Conclusion Hollow lag screws combined with reconstruction plates are reliable and effective when used to treat high anterior column fracture of the acetabulum with intact true pelvic brim.