自制弹簧钢板在髋臼后壁骨折手术中的应用

Application of self-made spring plate for treatment of acetabular posterior wall fractures

目的探讨自制弹簧钢板在手术治疗髋臼后壁骨折中的应用及疗效。方法 2013年6月-2017年6月,收治髋臼后壁骨折患者38例。男27例,女11例;年龄28~68岁,平均53岁。致伤原因:交通事故伤18例,高处坠落伤15例,跌倒伤5例。其中,单纯后壁骨折4例,后壁骨折伴髋关节后脱位18例,后壁骨折伴后柱骨折10例,后壁骨折伴横断骨折6例。受伤至入院时间1~4 d,平均2.5 d;受伤至手术时间4~8 d,平均5 d。采用Kocher-Langenbeck入路(35例)和联合髂腹股沟入路(3例)复位骨折后,首先采用弹簧钢板压住固定后壁骨折,然后使用重建钢板压住弹簧钢板固定于后柱。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间12~36个月,平均28个月。发生创伤后坐骨神经损伤5例及术中牵拉致坐骨神经损伤2例,均在术后3个月完全恢复。影像学复查示骨折均愈合,骨折愈合时间10~16周,平均12周。随访期间无内固定物断裂和失效发生;末次随访时发生股骨头坏死2例,创伤性关节炎1例,骨化性肌炎1例。术后12个月根据Harris评分标准评价髋关节功能,获优27例,良5例,可2例,差4例。结论髋臼后壁骨折术中使用弹簧钢板固定后壁骨折块后,再使用重建钢板压住弹簧钢板固定于后柱,具有手术操作简便、固定可靠的优点。

Objective To investigate the application and effectiveness of self-made spring plate in surgical treatment of acetabular posterior wall fracturejavascript:void(0)s. Methods Between June 2013 and June 2017, 38 patients with acetabular posterior wall fractures were treated. There were 27 males and 11 females with an average age of53 years(range, 28-68 years). The injury caused by traffic accident in 18 cases, falling from height in 15 cases, and tumble in 5 cases. There were 4 cases of simple posterior wall fracture, 18 cases of posterior wall fracture with posterior dislocation of hip joint, 10 cases of posterior wall fracture with posterior column fracture, and 6 cases of posterior wall fracture with transverse fracture. The time from injury to admission was 1-4 days(mean, 2.5 days). The time from injury to operation was 4-8 days(mean, 5 days). After fracture reduction via the Kocher-Langenbeck approach(35 cases) or the combined ilioinguinal approach(3 cases), the spring plate was used to press the posterior wall fracture, and then the reconstruction plate was pressed against the spring plate and fixed to the posterior column. Results All the incisions healed by first intention. All patients were followed up 12-36 months(mean, 28 months). Five cases of post-traumatic sciatic nerve injury and 2 cases of sciatic nerve injury caused by traction during operation were fully recovered at 3 months after operation.The imaging examination showed that all the fractures healed. The fracture healing time was 10-16 weeks(mean, 12 weeks). There was no ruptures or failures of internal fixation during the follow-up period. There were 2 cases of femoral head necrosis, 1 case of traumatic arthritis, and 1 case of osteomyositis at last follow-up. The hip joint function was rated as excellent in 27 cases, good in 5 cases, fair in 2 cases, and poor in 4 cases according to the Harris scores at 12 months after operation. Conclusion For the acetabular posterior wall fracture, it has the advantages of easy to use and reliable fixation that the posterior wall fracture is fixed with spring plate firstly, and the spring plate is pressed to fix the posterior column with the reconstruction plate finally.