新型解剖锁定钢板在髋臼前、后柱合并四方区骨折中的应用

The applications of a novel acetabulum anatomic locking plate for both column and quadrilateral surface fractures

目的探讨新型解剖锁定钢板在髋臼前、后柱及四方区骨折中的应用价值。方法回顾性分析2014年7月至2015年4月应用新型解剖锁定钢板治疗6例髋臼前、后柱及四方区骨折患者资料，男4例，女2例；年龄24-52岁，平均35．1岁；受伤至手术时间2-12d，平均7．2d；Letournel-Judet分型均为髋臼双柱骨折；均合并四方区骨折。6例患者均行高位髂腹股沟入路，采用新型解剖锁定钢板同时固定髋臼前、后柱骨折及阻挡四方区。术后采用Matta复位标准评价骨折复位情况，采用Merled’Aubigne—Postel评分评定髋关节功能。结果6例患者均获得随访，随访时间12-22个月，平均14个月；平均出血量860ml，平均手术时间286min；骨折均愈合，愈合时间为3-6个月，平均4．3个月。末次随访时根据Matta复位标准，解剖复位4例（66．7％，4／6），满意复位1例（16．7％，1／6），不满意复位1例（16．7％，1／6），满意率为83．3％（5／6）；Merled’Aubigne—Postel评分为11-18分，平均16．7分，其中优4例，良1例，可1例，优良率为83．3％（5／6）。1例患者术中出现髂内动脉损伤，行单侧髂内动脉栓塞术，术后6个月随访功能恢复良好；1例患者术后出现伤口脂肪液化，经伤口换药1周后愈合；术后6例患者无一例出现感染、股骨头缺血性坏死及创伤性关节炎等并发症。结论对于累及髋臼四方区的复杂髋臼骨折，新型解剖锁定钢板可以提供坚强、牢靠的固定，且可以通过单一前方入路同时固定髋臼前、后柱及四方区，术后骨折复位满意，髋关节功能恢复良好。

Objective To explore the design of a novel acetabulum anatomic locking plate and the clinical application for both column and quadrilateral surface fractures. Methods Clinical and follow-up data of 6 patients with both column fractures involving the quadrilateral plate managed operatively by a novel acetabulum anatomic locking plate from July 2014 to April 2015 were retrospectively analyzed. Among them 4 cases were male and 2 cases were female, with an average age of 35.1 years old （range, 24-52 years old）. The mean time from injury to operation was 7.2 d （range, 2-12 d）. According to the fracture classification of Letournel-Judet, there were all associated with two column fractures involving the quadrilateral plate.. All patients managed operatively by the novel acetabulum anatomic locking plate, which can simultaneous manage both column and quadrilateral surface fractures through the single superior ilioinguinal approach. The image results by Matta standard were evaluated and the results of acetabular function after surgery were assessed by Merle d＇ Aubigne-Postel. Results The 6 patients were followed up for at least 14 months （range, 12-22 months）. Average blood loss was 860 ml, and average operative time was 286 min. The mean time of bony union was 4.3 months. According to the criteria described by Matta, 66.7% of the reductions were graded excellent, 16.7% were graded good, and 16.7% were poor. Clinical outcomes （Merle d＇Aubigne-Postel） at 12 months were 66.7% excellent, 16.7% good, and 16.7% poor. One patient （4.5%） had an iatrogenic injury of internal iliae artery during operation. Unilateral iliac artery embolization was performed. One patient had a fatty fluidization. No surgical site infection, femoral head avascular necrosis and traumatic arthritis occurred. Conclusion The novel acetabulum anatomic locking plates for both column and quadrilateral surface can provide strong and stable fixation for complex acetabular fractures through the single superior ilioinguinal approach. It can achieve satisfactory reduction and approving clinical functions.