临时钛板螺钉在移位性髋臼骨折切开复位内固定术中的应用

Temporary titanium plate screwing in open reduction and internal fixation for displaced acetabular fracture

目的探讨"临时钛板螺钉"在移位性髋臼骨折切开复位内固定术中的应用效果。方法回顾性分析2013年10月至2016年3月期间解放军三二三〇八部队骨科采用内固定手术治疗的28例(28髋)复杂髋臼骨折患者资料。男20例,女8例;年龄为24~68岁,平均42.3岁;受伤至手术时间为7~21d,平均14.5d。骨折按Letournel-Judet分型:后柱骨折2例,横形骨折4例,后柱伴后壁骨折5例,横形伴后壁骨折6例,T形骨折2例,前方伴后半横形骨折3例,双柱骨折6例。手术入路选择髋臼后侧或前后联合入路,28例患者均使用"临时钛板螺钉"固定骨折一侧,在保持关节内骨折间接解剖复位不丢失的基础上完成切开复位内固定,最后26例患者再去除临时固定,2例患者酌情保留临时固定。记录患者术后骨折复位质量、并发症发生情况及疗效等。结果28例患者术后获10~36个月(平均15.6个月)随访。术后骨折复位质量按Matta评分标准评定:解剖复位26例,复位不满意1例,复位差1例,解剖复位率为92.9%。末次随访时根据改良Merle d’Aubigne&Postel评分标准评定疗效:优27例,良1例,优良率为100%。11例患者术后出现不同程度异位骨化,不影响关节功能;6例患者出现坐骨神经一过性麻痹,均于术后3个月内恢复。随访期间无一例患者发生股骨头缺血性坏死、行走疼痛等并发症。结论在移位性髋臼骨折的切开复位内固定术中使用钛板、螺钉临时固定可有效提高关节面的复位质量及固定稳定性,近期疗效满意。

Objective To explore the efficacy of temporary titanium plate screwing for positional maintenance in reduction and internal fixation for displaced acetabular fractures. Methods A retro-spective study was conducted of the 28 patients (28 hips) with displaced acetabular fracture who had been treated by open reduction and internal fixation from October 2013 to March 2016. They were 20 males and 8 females, aged from 24 to 68 years (average, 42.3 years). The time from injury to surgery ranged from 7 to 21 days(average, 14.5 days). According to the Letournel-Judet classification, there were 2 posterior column fractures, 4 transverse fractures, 5 posterior column plus posterior wall fractures, 6 transverse plus posterior wall fractures, 2 T-shaped fractures, 3 anterior and posterior transverse fractures and 6 double column fractures. The posterior acetabular approach or combined anterior and posterior approach was used. In all the patients temporary titanium plate screwing was conducted to fix one side of the fracture so as to facilitate accomplishment of open reduction and internal fixation without losing the indirect anatomic reduction of the in-traarticular fracture. After the open reduction and internal fixation was accomplished, the temporary screw fixation was removed in 26 patients but retained in 2 patients as needed. The reduction quality, complications and outcomes at the final follow-ups were recorded. Results All the 28 patients were followed up for 10 to 36 months (mean, 15.6 months). By the Matta criteria, anatomical reduction was achieved in 26 cases, unsatisfactory reduction in one and poor reduction in one, yielding an anatomic reduction rate of 92.9%. By the improved Merle d’Aubigne & Postel criteria, the clinical outcomes at the final follow-up were excellent in 27 cases and good in one, yielding a good to excellent rate of 100%. Postoperatively, heterotopic ossification of different severities occurred in 11 cases but did not affect their joint function;transient paralysis of the sciatic nerve was reported in 6 cases but recovered 3 months after surgery. No complications like avascular necrosis of the femoral head or walking pain were observed during follow-ups. Conclusion Temporary fixation with titanium plate screws during open reduction and internal fixation for displaced acetabular fractures can effectively improve the reduction and fixation of the articular surface, leading to satisfactory short-term clinical outcomes.