钛网结合重建钢板治疗累及四方区粉碎的复杂髋臼骨折

Treatment of complex acetabular fractures involving comminuted quadrilateral plate by reconstruction plate combined with titanium mesh

目的探讨应用钛网结合重建钢板治疗伴有四方区粉碎的复杂髋臼骨折的临床疗效.方法2010年1 月至2014 年12 月山东大学附属省立医院采用重建钢板加钛网治疗9 例累及四方区粉碎的复杂髋臼骨折患者,其中男7 例,女2 例;年龄24～52 岁,平均年龄42.5 岁;根据Letournel-Judet 分型双柱骨折7 例、前柱伴后半横行骨折2 例;受伤至手术时间2～25 d,平均时间9 d.末次随访时按Matta 复位标准和改良Merle D＇Aubigne标准分别评估患者术后骨折复位质量和髋关节功能.结果9 例患者随访9～30 个月,平均随访时间25 个月;患者髋臼均获骨性愈合,愈合时间3～5 个月,平均愈合时间3.6 个月.末次随访时Matta 骨折复位评价：解剖复位4 例、满意复位2 例、不满意复位3 例;Matta 髋臼骨折评分为12～18 分（平均16.3 分）,优3 例、良4 例、可1 例、差1 例.深静脉血栓1 例,治疗4 周后好转;异位骨化2 例,无明显不适,未予处理;创伤性关节炎2 例,服用非甾体类抗炎药物后缓解;无切口感染、股骨头缺血性坏死、螺钉松动、钛网松开或断裂并发症发生.结论对于伴有四方区粉碎的复杂髋臼骨折,采取钛网结合重建钢板可维持复位,恢复髋臼正常匹配关系,是-种有效的内固定方法.

Objective To explore clinical effects of reconstruction plate with tatinium mesh for the treatment of complex acetabular fractures involving comminuted quadrilateral plate. Methods From January 2010 to December 2014, 9 patients suffered from complex acetabular fractures involving comminuted quadrilateral plate were treated by reconstruction plate and titanium mesh fixation in Shandong Provincial Hospital Affiliated to Shandong University. Among them 7 cases were male and 2 were female, with an average age of 42.5 years old(range, 24-52 years old). According to Letournel and Judet Classification, there were two-column fractures in7 cases, while anterior column and posterior hemitransverse fractures in 2 cases. The duration from injury to fixation was 2 to 25 days(average, 9 days). At the latest follow-up, the quality of fracture reduction was assessed according to Matta reduction criterion, hip function was evaluated by modified Merle D'Aubigne scoring system of acetabular fracture. Results All patients obtained an average follow-up of 25 months(range, 9 to 30 months),and they all reached solid bone healing, with the healing time of 3.6 months(3-5 months). At the latest follow-up, there were anatomic reduction in 4 cases, satisfactory reduction in 2, unsatisfactory reduction in 3based on Matta reduction standard; The average Matta score was 16.3(12-18), and there was excellent in 3cases, good in 4, fair in 1, and poor in 1. Deep venous thrombosis occurred in 1 patient who was improved after4 weeks' treatment; Two patients had heterotopic ossification without treatment because of no obvious symptoms;Traumatic arthritis occurred in 2 cases whose symptoms had been relieved after treatment of non-steroidal anti-inflammatory drugs; No complications such as incision infection, ischemic femoral head necrosis, screw loosening, titanium mesh loosening or breakage occurred. Conclusion For complex acetabular fractures involving comminuted quadrilateral plate, reconstruction plate combined with titanium mesh fixation is an effective surgical procedure because it could maintain the articular surface and provide precise anatomical reduction.