骨盆前壁锁定钢板固定累及方形区的髋臼骨折

Anterior locking plate for internal fixation of acetabular fractures involving quadrilateral area

摘要:

[目的] 探讨骨盆前壁锁定钢板治疗累及方形区的髋臼骨折的临床疗效。[方法] 回顾性分析本院 2017 年 1 月— 2020 年 12 月应用骨盆前壁锁定钢板治疗累及方形区髋臼骨折 32 例患者的临床资料。其中，前壁伴后半横型骨折 6 例，横型骨折 7 例，双柱骨折 12 例，T 型骨折 7 例。通过腹直肌外侧入路显露髋臼，选择骨盆前壁锁定钢板结合重建钢板固定。总结临床与影像资料。[结果] 32 例患者均顺利完成手术，术中无血管、神经损伤。随访时间 12~41 个月，平均(25.84±10.95)个月。患者完全负重活动时间为(11.93±3.62)周。随时间推移，患髋伸屈和内外旋 ROM 显著增加(P＜0.05)。按 Merled'Aubigné -Postel 评级，优 22 例、良 6 例、可 3 例、差 1 例，优良率为 87.50% (28/32)；根据 Matta 影像学评估，解剖复位 23 例 (71.88%)，满意复位 7 例(21.88%)，不满意复位 2 例(6.25%)，满意率为 93.75%(30/32)，末次随访时，所有患者均达到骨性愈合，无异位骨化、股骨头坏死和内固定松动等不良表现。[结论]骨盆前壁锁定钢板固定累及方形区髋臼骨折可靠，临床疗效满意。

Abstract:

[Objective] To explore the clinical outcomes of the anterior locking plate for internal fixation of acetabular fractures involv- ing quadrilateral area. [Methods] A retrospective study was done on 32 patients who received open reduction and internal fixation (ORIF) for acetabular fractures involving quadrilateral area in our hospital from January 2017 to December 2020. Based on Letournel-Judet classi- fication, 6 patients were of anterior wall combined with posterior semi-transverse fractures, 7 were of transverse fractures, 12 were of dou- ble-column fractures and 7 of T-shaped fractures. All patients had fractures fixed with anterior locking plate combined with the reconstruc- tion plate through the lateral rectus approach. The clinical and radiographic documents were summarized. [Results] All patients had ORIF performed smoothly without iatrogenic injury to blood vessels and nerves, and followed up for 12~41 months, with an average of (25.84± 10.95) months. The patients resumed full-weight bearing activity in (11.93±3.62) weeks on average, and got significant increases of hip flex- ion-extension and internal-external rotation range of motions (ROM) over time. According to Merled' Aubigné-Postel criteria, the clinical outcomes were marked as excellent in 22, good in 6, fair in 3 and poor in 1, with excellent and good rate of 87.50% (28/32) . In term of Mat- ta criteria, anatomic reduction achieved in 23 cases (71.88%) , satisfactory reduction was in 7 cases (21.88%) and unsatisfactory reduction was in 2 cases (6.25%) , with total satisfactory rate of 93.75% (30/32) . To the latest follow up, all the patients got fracture healing without adverse imaging findings, such as heterotrophic ossification, femoral head necrosis and implant loosening. [Conclusion] The anterior lock- ing plate for internal fixation of acetabular fractures involving the quadrilateral area is reliable technique to achieve satisfactory clinical out- comes.