髋臼骨折后方内固定术后创伤性关节炎患者的内植物分析

Implant analysis of patients with traumatic arthritis after posterior internal fixation of acetabular fractures

目的:从内植物技术角度剖析髋臼骨折后方接骨板内固定手术的失败原因及解决方法。方法:回顾性分析2011年1月至2021年12月,从国内10家医院收集的行全髋关节置换术(THA)治疗的髋臼骨折后方接骨板内固定术后创伤性关节炎患者的临床资料。男24例,女3例;年龄37~62岁,平均(49.5±1.2)岁。内固定手术至THA的时间为8~42个月,中位数18.0(16.9,18.3)个月。调阅患者的住院病历、THA手术前后的X线和CT检查资料,从内植物并发症、髋关节骨结构损伤两个层面进行分析。结果:左侧固定77.8%(21例),右侧固定22.2%(6例)。1块重建接骨板固定40.7%(11例)、2块重建接骨板固定55.6%(15例)、4块重建接骨板固定3.7%(1例);螺钉固定数量每例4~15枚。内植物并发症:内植物侵蚀股骨头33.3%(9例)>螺钉滑脱11.1%(3例)>螺钉断裂3.7%(1例)。骨结构损伤:股骨头骨缺损96.3%(26例)>负重区关节面塌陷+后壁骨吸收/坏死77.8%(21例)>股骨头脱位70.4%(19例)>负重区关节面塌陷63.0%(17例)>后壁外缘骨块吸收/坏死55.6%(15例)>关节内骨赘增生11.1%(3例)>髋臼硬化7.4%(2例)、囊性变7.4%(2例)。未有效固定部位:负重区+后壁70.4%(19例)>负重区63.0%(17例)>后壁55.6%(15例)>后柱7.4%(2例)。结论:负重区+后壁关节面骨块未有效固定是导致后方内植物失败的关键因素,内植物失败并发症和骨结构损伤与接骨板螺钉分布直接相关。

Objective:To analyze the causes of the failure of posterior plate fixation for acetabular fractures and find the solutions from the perspective of implant technology.Methods:A retrospective analysis was conducted on clinical data of patients with traumatic arthritis after posterior fixation of acetabular fractures treated by total hip arthroplasty(THA)between January 2011 and December 2021 at 10 hospitals.There were 24 males and 3 females,who were 37-62 years old with a mean age of(49.5±1.2)years.The time from internal fixation surgery to THA ranged from 8 to 42 months,with a median time of 18.0(16.9,18.3)months.The patients'medical records,X-ray and CT examination data before and after THA were reviewed,and the analysis was conducted from the two levels of implant complications and hip joint bone damage.Results:There were 77.8%(21 cases)of left-side fixation and 22.2%(6 cases)of rightside fixation.The number of reconstructed plates fixed was 1 in 40.7%(11 cases),2 in 55.6%(15 cases),and 4 in 3.7%(1 case);the number of screws fixed was 4-15 per case.Of implant complications,erosion of the femoral head occurred in 33.3%(9 cases)of cases,screw slippage in 11.1%(3 cases)of cases,and screw breakage in 3.7%(1 cases)of cases.Of bone structure damage,femoral head defect occurred in 96.3%(26 cases)of cases,load-bearing collapse and posterior wall absorption/necrosis occurred in 77.8%(21 cases)of cases,femoral head dislocation occurred in 70.4%(19 cases)of cases,load-bearing collapse occurred in 63.0%(17 cases)of cases,posterior wall absorption/necrosis occurred in 55.6%(15 cases)of cases,intra-articular osteophyte occurred in 11.1%(3 cases)of cases,and acetabular sclerosis and cystic changes occurred in 7.4%(2 cases)of cases.Of ineffective fixation sites,load-bearing area and posterior wall were 70.4%(19 cases)of cases,load-bearing area was 63.0%(17 cases)of cases,posterior wall was 55.6%(15 cases)of cases,posterior column was 7.4%(2 cases)of cases.Conclusions:Ineffective fixation of the load-bearing area and posterior wall is the key factor leading to the failure of posterior implant technology.The collapse of the load-bearing and posterior wall absorption/necrosis are the most common forms of acetabular injuries.Femoral head defect caused by implant erosion is the most common implant complication.