髋臼下螺钉技术治疗髋臼骨折的疗效分析

Treatment of acetabular fractures with infra-acetabular screwing

目的探讨髋臼下螺钉技术治疗髋臼骨折的临床疗效。方法回顾性分析2016年1月至2019年1月期间新疆医科大学附属中医医院创伤骨科收治的22例髋臼骨折患者资料。男16例,女6例;年龄为19~65岁,平均45.2岁。根据Letournel-Judet分型:前柱骨折2例,前方伴后半横形骨折12例,T形骨折3例,双柱骨折5例。所有患者均采用髂腹股沟入路内固定并髋臼下螺钉技术治疗。记录患者的手术时间、术中出血量、骨折复位质量、骨折愈合时间、髋关节功能及并发症发生情况等。结果本组患者的手术时间为115~285 min,平均160 min;术中出血量为360~1600 mL,平均650 mL。术后骨折复位质量根据Matta评分标准评定:优14例,良5例,差3例,优良率为86.4%(19/22)。21例患者术后获12~45个月(平均28.5个月)随访,1例失访。21例患者的骨折愈合时间为1.6~3.0个月,平均2.2个月。无一例患者出现骨折移位。末次随访时髋关节改良Merle d’Aubigné&Postel评分为8~18分,平均16分;优12例,良6例,可2例,差1例,优良率为85.7%(18/21)。随访期间1例患者出现股外侧皮神经损伤,2例患者出现下肢深静脉血栓形成,1例患者并发切口浅表感染,1例患者并发创伤性关节炎,总并发症发生率为23.8%(5/21)。结论髋臼骨折解剖复位后应用髋臼下螺钉技术能够有效增强内固定强度,避免骨折再移位,有利于患者早期进行功能锻炼,临床疗效佳。

Objective To investigate the clinical efficacy of infra-acetabular screwing in the treatment of acetabular fractures.Methods A retrospective analysis was conducted of the 22 patients with acetabular fracture who had been admitted to Department of Trauma and Orthopedics,The Affiliated Hospital of Traditional Chinese Medicine,Xinjiang Medical University from January 2016 to January 2019.They were 16 males and 6 females,aged from 19 to 65 years(mean,45.2 years).According to Letournel-Judet classification,there were 2 anterior column fractures,12 anterior plus posterior hemi-transverse fractures,3 T-shaped fractures and 5 both-column fractures.All patients were treated with infra-acetabular screwing through the ilioinguinal approach.Recorded were the patients'operation time,intraoperative blood loss,reduction quality,fracture union time,hip function and complications.Results Operation time for this cohort ranged from 115 to 285 min(mean,160 min),and intraoperative blood loss from 360 to 1,600 mL(mean,650 mL).By the Matta scoring,fracture reduction was assessed as excellent in 14 cases,as good in 5 cases and as poor in 3 cases,giving an excellent and good rate of 86.4%(19/22).Of this cohort,21 were followed up from 12 to 45 months(mean,28.5 months)and one was lost to the follow-up.The fracture healing time for 21 patients ranged from 1.6 to 3.0 months,averaging 2.2 months.No patient had fracture displacement.The Merle d’Aubigné&Postel hip scores at the last follow-up ranged from 8 to18 points(average,16 points),giving 12 excellent,6 good,2 fair,and one poor cases and an excellent and good rate of 85.7%(18/21).Follow-ups observed injury to the lateral femoral cutaneous nerve in one case,deep venous thrombosis of lower limb in 2 cases,superficial wound infection in one case and traumatic arthritis in one case,yielding a total rate of compilations of 23.8%(5/21).Conclusion Application of infra-acetabular screwing after anatomical reduction of an acetabular fracture can effectively enhance the strength of internal fixation with no risk of fracture re-displacement,conducive to early functional exercise of the patient and leading to good clinical efficacy.