髋臼四方区组合钢板治疗髋臼双柱骨折

Combined acetabular quadrilateral surface plates for the treatment of both column fractures

目的 探讨髋臼四方区组合钢板治疗髋臼双柱骨折的临床有效性和可靠性。方法 回顾性分析2016年6月至2017年8月采用髋臼四方区组合钢板治疗15例髋臼双柱骨折患者资料,男9例,女6例;年龄26~68岁,平均42.8岁;均为Letournel-Judet分型的髋臼双柱骨折,其中4例合并无后脱位机制后壁骨折。术前均采集患者DICOM格式骨盆CT薄层扫描数据,采用3D打印技术打印患者骨盆模型,充分了解骨折情况及特点,并将健侧半骨盆进行镜像打印,然后在镜像打印半骨盆模型上,模拟髋臼四方区组合钢板安放,钢板塑形备用。手术采用高位髂腹股沟入路,满意复位后依次置入预弯好的弓状缘内侧钢板（主板）、耻坐钢板、髂坐钢板,分别固定前、中、后三柱,其中耻坐钢板、髂坐钢板分别与主板相组合。结果 手术时间100~240 min,平均150 min;术中出血量600~1 500 ml,平均850 ml;手术切口长度9~13 cm,平均11 cm;术中骨折满意复位后,置入预弯钢板,钢板与钢板、钢板与骨面均贴服良好。术后骨折复位按Matta标准评价,15例患者中,优9例,良4例,可2例,优良率86.7%（13/15）。15例患者均获得随访,随访时间6~12个月,平均10个月。末次随访时髋关节功能按Matta改良的Merle d＇Aubigne和Postel评分系统评分,为12~18分,平均16.4分,其中优8例,良4例,可2例,差1例,优良率80.0%（12/15）。结论 髋臼四方区组合钢板治疗髋臼双柱骨折,一方面可阻挡四方区内侧移位,另一方面可牢靠固定完全漂浮的后柱及坐骨体;该钢板为多维度框架固定,安全有效,临床疗效满意。

Objective To explore the clinical effectiveness and reliability of combined acetabular quadrilateral surface plates for the treatment of both column fractures. Methods From June 2016 to August 2017, data of 15 cases with acetabular both column fractures who were treated in our department were retrospectively analyzed. Among them 9 cases were male and 6 were female. The mean age was 42.8 years （range, 26-68 years）. All cases were both column fractures according to the Letournel-Judet’s classification, including 4 cases combined with posterior wall fracture. Before operation, the pelvic CT thin layer scanning data of patients were collected in DICOM format, and then the data were imported to print the simulated model by 3D printing technology in order to understand the characteristics of fracture directly. The contralateral half pelvis was mirror printed in order to simulate the placement of combined quadrilateral surface plates and preshape all plates. During operation, infrapectineal main plate, pubo-ischiatic plate and ilio-ischiatic plate were placed consequently to fix the anterior column, “middle column” and posterior column respectively. The pubo-ischiatic and ilio-ischiatic plates were combined with the main plate. All cases were operated by supra-ilioinguinal approach. Results The average incision length was 11 cm （range, 9-13 cm）. The average operative time was 150 min （range, 100-240 min）. The average blood loss was 850 ml （range, 600-1500 ml）. Once reduction was obtained, plates could be placed easily and adhere to bone surface well. The quality of postoperative fracture reduction was evaluated according to Matta standard, of which there were 9 cases excellent, 4 cases good, and 2 cases poor, with an excellent rate of 86.7% （13/15）. All patients were followed up for an average time of 10 months （range, 6-12 months）. At the latest follow-up, the average modified Merle d ＇Aubigne and Postel score was 16.4 （range, 12-18）, and there were 8 cases excellent, 4 cases good, 2 cases fair and 1 case poor, with an excellent rate of 80.0% （12/15）. Conclusion For the treatment of acetabular both column fractures, the combined quadrilateral surface plates could resist the medial displacement of quadrilateral area, and on the other hand the total floating posterior column and ischium could be fixed firmly. At the same time, this plate system is a multi-dimensional framework fixation, which is more effective and safer with lower complications rate, resulting in a satisfactory clinical outcomes.