数字化术前设计辅助动力化前路方形区钛板螺钉系统在髋臼双柱骨折手术治疗中的应用

Application of dynamic anterior titanium plate-screw system assisted by preoperative digital design in treatment of acetabular bi-column fractures

目的探讨数字化术前设计辅助动力化前路方形区钛板螺钉系统(DAPSQ)治疗髋臼双柱骨折的临床疗效。方法采用回顾性病例对照研究分析2012年1月—2018年1月解放军中部战区总医院收治的34例髋臼双柱骨折患者临床资料,其中男24例,女10例;年龄21~65岁[(43.0±14.2)岁]。17例采用数字化术前设计辅助DAPSQ治疗(A组),17例采用常规DAPSQ治疗(B组)。A组男11例,女6例;年龄22~64岁[(42.7±12.4)岁]。B组男13例,女4例;年龄21~65岁[(43.2±14.6)岁]。比较两组手术时间、术中出血量、住院时间、骨折愈合时间、骨折复位质量Matta放射学标准评分、髋关节功能改良Merle d'Aubigné-Postel评分及并发症情况。结果34例患者均获随访12~62个月[(32.8±9.1)个月]。A组手术时间[(160.8±38.5)min]和术中出血量[(455.6±190.4)ml]均显著少于B组[(216.9±59.5)min、(780.2±211.6)ml](P<0.05)。两组住院时间、骨折愈合时间、Matta放射学标准评分、末次随访时改良Merle d'Aubigné-Postel评分比较,差异均无统计学意义(P>0.05)。A组出现髋关节创伤性关节炎4例(1例行人工全髋关节置换),B组出现髋关节创伤性关节炎3例,股骨头缺血性坏死1例(行人工全髋关节置换)。两组无一例出现螺钉进入关节腔、内固定失效及切口感染等并发症。结论对于髋臼双柱骨折,DAPSQ内固定可有效维持骨折稳定,无螺钉进入关节腔风险,可获得满意的临床疗效。与常规DAPSQ比较,数字化术前设计辅助DAPSQ治疗髋臼双柱骨折可显著缩短手术时间,减少术中出血量。

Objective To investigate the clinical efficacy of dynamic anterior plate-screw system(DAPSQ)assisted by preoperative digital design in the treatment of acetabular bi-column fractures.Methods A retrospective case-control study was conducted to analyze the clinical data of 34 patients with acetabular bi-column fractures admitted to the General Hospital of Central Theater Command from January 2012 to January 2018.There were 24 males and 10 females,aged 21-65 years[(43.0±14.2)years].According to the treatment method,the patients were divided into Group A treated with DAPSQ assisted by preoperative digital design and Group B treated with conventional DAPSQ.Group A was consisted of 17 patients,including 11 males and six females aged 22-64 years[(42.7±12.4)years].Group B consisted of 17 patients,including 13 males and four females aged 21-65 years[(43.2±14.6)years].The operation time,intraoperative blood loss,hospitalization time,fracture healing time,Matta radiological standard score of fracture reduction,Merle d'Aubignre-Postel score and complications were recorded and compared between the two groups.Results All patients were followed up for 12-62 months[(32.8±9.1)months].The operation time[(160.8±38.5)minutes]and intraoperative bleeding[(455.6±190.4)ml]in Group A were significantly less than those in Group B[(216.9±59.5)minutes]and[(780.2±211.6)ml](P<0.05).There were no significant differences in hospitalization time,fracture healing time,Matta radiological standard score,modified Merle d'Aubignre-Postel score at the last follow-up between the two groups(P>0.05).In Group A,four patients had traumatic arthritis,with one patient receiving total hip replacement.In Group B,three patients were found with traumatic arthritis,and one with avascular necrosis of femoral head who underwent total hip replacement.None of the two groups had complications such as screws'entry into articular cavity,failure of internal fixation,and incision infection.Conclusions For acetabular bi-column fractures,DAPSQ can effectively maintain the stability of the fracture,without the risk of screws entering the joint cavity,and obtain satisfactory clinical effect.Compared with conventional DAPSQ,preoperative digital design can significantly shorten the operation time and reduce intraoperative bleeding.