后壁压缩对切开复位内固定治疗髋臼后壁骨折疗效的影响研究

Effect of the impaction of posterior wall on the prognosis following open reduction and internal fixation for fractures of acetabular posterior wall

目的探讨后壁压缩对切开复位内固定治疗髋臼后壁骨折疗效的影响。方法回顾性分析2017年1月至2020年12月期间首都医科大学附属北京积水潭医院创伤骨科采用切开复位内固定治疗的83例髋臼后壁骨折患者资料。根据后壁压缩与否分为两组:压缩组33例,男26例,女7例;年龄(47.4±11.6)岁;后壁存在压缩。非压缩组50例,男43例,女7例;年龄(41.3±12.0)岁;后壁无压缩。比较两组患者的术后骨折复位质量、末次随访时患髋功能及随访期间并发症发生率等。采用多因素二元logistic回归和年龄亚组分析髋臼后壁压缩对功能结局的影响。结果压缩组患者的年龄、合并其他部位损伤比例及髋臼后壁粉碎比例显著大于非压缩组患者,差异均有统计学意义(P<0.05);而两组患者其他一般资料比较差异均无统计学意义(P>0.05)。所有患者术后获(44.5±13.3)个月随访。非压缩组患者术后骨折解剖复位率(96.0%,48/50)显著高于压缩组患者(57.6%,19/33),末次随访时改良Merle d’’Aubigné & Postel评分优良率(84.0%,42/50)也显著高于压缩组患者(51.5%,17/33),差异均有统计学意义(P<0.05)。两组患者的并发症发生率比较差异无统计学意义(P>0.05)。校正年龄、性别等一般资料后,两组患者髋关节功能比较差异仍有统计学意义(OR=0.23,95%CI:0.06~0.79,P=0.020)。后壁压缩对功能结局的影响在年龄≥50岁患者中差异有统计学意义(P=0.008),而在年龄<50岁患者中差异无统计学意义(P=0.194)。结论在髋臼后壁骨折中,相较于非压缩骨折,压缩骨折更容易导致较差的骨折复位质量,从而影响患者术后髋关节功能的恢复。后壁压缩对功能结局的影响在年龄≥50岁患者中更为显著。

Objective To evaluate the effect of the impaction of posterior wall on the prognosis following open reduction and internal fixation for fractures of acetabular posterior wall.Methods A retrospective study was conducted to analyze the data from the 83 patients with fracture of acetabular posterior wall who had been consecutively treated by open reduction and internal fixation at Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital from January 2017 to December 2020.The patients were divided into 2 groups based on involvement of posterior wall impaction.In the impaction group of 33 cases,there were 26 males and 7 females with an age of(47.4±11.6)years;in the non-impaction group of 50 cases,there were 43 males and 7 females with an age of(41.3±12.0)years.The quality of postoperative fracture reduction,the function of the affected hip at the last follow-up,and the complication rate during follow-up were compared between the 2 groups.Multifactorial binary logistic regression and age subgroups were used to analyze the effects of posterior wall impaction on functional outcomes.Results The age,rate of associated injuries in other body parts,and rate of posterior wall comminution in the impaction group were significantly higher than those in the non-impaction group(P<0.05),but there was no statistically significant difference in other general data of patients between the 2 groups(P>0.05).All patients were followed up for(44.5±13.3)months after surgery.The rate of anatomical reduction in the non-impaction group(96.0%,48/50)was significantly higher than that in the impaction group(57.6%,19/33)(P<0.05),and the good and excellent rate by the modified Merle d'Aubigné&Postel scale at the last follow-up in the non-impaction group(84.0%,42/50)was significantly higher than that in the impaction group(51.5%,17/33)(P<0.05).There was no significant difference in the incidence of complications between the 2 groups(P>0.05).After adjusting for age and gender,the difference in hip function was still significantly different between the 2 groups(OR=0.23,95%CI:0.06 to 0.79,P=0.020).The effect of posterior wall impaction on functional outcomes was statistically significant in patients aged≥50 years(P=0.008),whereas the difference was not statistically significant in patients aged<50 years(P=0.194).Conclusions Compared with non-impaction ones,acetabular fractures of posterior wall impaction tend to lead to poorer quality of reduction,which in turn affects the postoperative recovery of hip joint function.The impact of impaction fractures on functional recovery is more significant in patients aged 50 years and above.