单钢板与平行双解剖锁定钢板治疗髋臼后壁骨折比较

Single plate versus parallel double plates for acetabular posterior wall fracture

[目的]比较单钢板与平行双髋臼解剖锁定钢板治疗髋臼后壁骨折的疗效。[方法]回顾性分析2016年1月~2018年1月本院收治的32例髋臼后壁骨折患者资料,男20例,女12例;年龄22~62岁。所有患者均采用Kocher-Langenbeck入路,其中17例采用一枚解剖锁定钢板固定,15例采用双钢板固定。比较两组患者的围手术期、随访和影像资料。[结果]32例患者顺利完成手术,双钢板组1例出现轻度足背感觉及足趾背伸障碍的坐骨神经损伤症状,经营养神经治疗,术后4个月恢复。单钢板组患者的手术时间、术中出血量均显著少于双钢板组患者,差异均有统计学意义(P<0.05)。两组患者随访10~24个月,所有患者均末发生再骨折、髋关节脱位、关节僵硬等严重问题。随术后时间推移,两组患者疼痛均逐步减轻、功能改善。双钢板组完全负重时间显著早于单钢板组,差异有统计学意义(P<0.05)。随术后时间推移两组患者VAS评分均显著减少,而Harris评分和改良Merled’Aubigné及Postel评分显著增加,不同时间点差异有统计学意义(P<0.05),但相同时间点,双钢板组的VAS、Harris和Merled’Aubigné及Postel评分优于单钢板组,尽管差异均无统计学意义(P>0.05)。影像评估方面,按改良的Matta评定分级标准,骨折复位质量优良率单钢板组为82.35%;双钢板组为优良率为86.67%。[结论]平行双髋臼解剖锁定钢板固定髋臼后壁骨折可获得更好的骨折稳定性,以便于髋关节功能恢复。

[Objective]To compare the clinical outcomes of a single plate versus parallel double plates for open reduction and internal fixation(ORIF)of acetabular posterior wall fractures.[Methods]A retrospective study was conducted on 32 patients who underwent ORIF for acetabular posterior wall fracture between January 2016 and January 2018,including 20 males and 12 females aged from 22 to 62 years.All the patients had ORIF through the Kocher-Langenbeck approach with 17 patients using a single anatomical locking plate,whereas the remaining 15 patients using two anatomical locking plates placed parallelly.The perioperative,follow-up and radiographic documentations were compared between the two groups.[Results]All the patients received successful operations,although one patients in the double-plate group suffered from sciatic nerve injury,with symptoms of sensory disturbance on dorsal foot and dysfunction of dorsal flexion of the foot,which completely recovered in 4 months by conservative therapy.The single-plate group consumed significantly shorter operation time,associated with significantly less blood loss than the double-plate group(P<0.05).The follow-up period ranged from 10 to 24 months,the patients in both groups got pain relief and functional improvement,without refracture,re-dislocation and severe hip stiffness.The doubleplate group returned full weight bearing significantly early than the single-plate group(P<0.05).As time went postoperatively,the VAS score significantly decreased,whereas the Harris score and Merled’Aubigné&Postel score significantly increased(P<0.05).The double-plate group was slightly superior to the single-plate group in aforesaid scores at corresponding time points,regardless on statistically significant differences between them(P>0.05).In term of radiographic assessment,the excellent and good rate of fracture reduction proved of 82.4%in the single-plate group,while 86.7%in the double-plate group.[Conclusion]For ORIF of acetabular posterior wall fractures,the parallel double anatomical locking plates do provide improved stability to facilitate function recovery.