跨弓状缘髋臼四方区阻挡钢板治疗复杂髋臼骨折

The supra-pectineal quadrilateral surface buttress plate for the treatment of complex acetabular fractures

目的介绍一种跨弓状缘髋臼四方区解剖钢板,探讨其在复杂髋臼骨折内固定治疗中的优缺点及临床疗效。方法回顾性分析2017年3月至2019年3月采用跨弓状缘髋臼四方区解剖钢板治疗18例髋臼骨折患者资料,其中男15例,女3例;年龄49.6岁(范围,27~62岁);根据Letournel-Judet分型:前柱骨折3例(累及四方区),T形骨折2例,前方伴后半横形骨折8例,双柱骨折5例;受伤至手术时间为7 d(范围,5~14 d)。患者术前均摄骨盆前后位X线片及CT+三维重建,充分了解骨折形态。手术均采用高位髂腹股沟入路,并使用跨弓状缘髋臼四方区阻挡钢板进行固定,记录手术时间、术中出血量及术后并发症。术后患者均摄标准前后位及Judet位骨盆X线片、CT+三维重建,按照Matta标准评价骨折复位情况,采用Matta改良的Merled’Aubigné-Postel评分评价髋关节功能。结果18例患者手术时间130 min(范围,100~200 min);术中出血量560 ml(范围,400~900 ml);跨弓状缘髋臼四方区解剖钢板术中均无需额外塑形,均顺利完成手术。18例患者均获得随访,随访时间9个月(范围,6~15个月),骨折均完全愈合。骨折复位按Matta评分标准评分,其中优11例、良4例、可3例,优良率83.3%(15/18)。末次随访时Matta改良的Merle d’Aubigné-Postel评分为15.8分(范围,12~18分),其中优10例、良6例、可2例,优良率88.9%(16/18)。术后2例患者出现股外侧皮神经损伤症状,1个月后好转;余无其他术后并发症。结论跨弓状缘髋臼四方区阻挡钢板可以同时固定髋臼前后柱及四方区,解剖型设计,无需塑形,安全性好,固定牢靠,术后并发症低,早期临床疗效满意。

Objective To introduce a novel anatomical supra-pectineal quadrilateral surface buttress plate,and explore its advantages,disadvantages and clinical efficacy in the treatment of complex acetabular fractures.Methods Data of eighteen cases of acetabular fractures treated in our department from March 2017 to March 2019were retrospectively analyzed.There were 15 males and 3 females with an average age of 49.6 years(range,27-62 years).According to the Letournel-Judet’s classification,there were 3 cases of anterior column fractures(involving quadrilateral surface),2 cases of"T"shaped,8 of cases anterior column and posterior hemi-transverse(ACPHT)and 5 cases of double columns fractures.The time from injury to operation was 5-14 days(mean,7 days).Before operation,all patients were taken pelvic anterior-posterior X-ray and CT scan.All patients were adopted supra-ilioinguinal approach and fixed by supra-pectineal quadrilateral surface buttress plate.Surgical time,intraoperative blood loss and postoperative complications were collected.After operations all patients were taken pelvic X-ray in anterior-posterior and Judet position,as well as CT scan.The radiographic quality of reduction was evaluated by Matta criteria and hip functions were evaluated by Matta Modified Merle d’Aubigné-Postel scoring system.Results The average surgical time was 130 min(range,100-200 min).The average blood loss was 560 ml(range,400-900 ml).An additional shaping was unnecessary in 18 patients who were implanted with the anatomical supra-pectineal quadrilateral surface buttress plate and all patients were operated successfully.All patients were followed up for an average time of 9 months(range,6-15 months).The quality of fracture reduction was evaluated according to Matta standard,of which there were 11 cases excellent,4 cases good,and 3 cases poor,with an excellent rate of 83.3%(15/18).At the latest follow-up,the function of the hip joint was evaluated according to the Matta Modified Merle d’Aubigné-Postel scoring system for a mean of 15.8 scores(range,12-18 scores),of which there were 10 cases excellent,6 cases good,2 cases fair,with an excellent rate of 88.9%(16/18).All patients recovered well,and there were 2 cases of lateral femoral cutaneous nerve injury postoperative who had recovered one month later.There was no other postoperative complications.Conclusion The anterior and posterior column and quadrilateral surface could be stabilized simultaneously by the anatomical supra-pectineal quadrilateral surface buttress plate without intraoperative shaping.Moreover,it is more likely to obtain a satisfactory clinical outcome by using this special plate with lower complications and rigid fixation.Therefore,it is a kind of internal fixation method worthy of promotion in the treatment of complex acetabular fractures.