摘要
目的探讨使用自主研发的髋臼后壁后柱一体化解剖钢板治疗后壁和(或)后柱骨折的可行性及临床疗效。方法回顾性分析2016年1月和2019年1月采用髋臼后壁后柱一体化钢板治疗21例髋臼后壁和(或)后柱骨折患者资料,男11例,女10例;年龄18~65岁,平均48岁。按照AO/OTA后壁骨折分型:简单骨折6例,粉碎性骨折9例,伴有关节面压缩的后壁骨折6例;其中单纯后壁骨折16例,后壁伴有后柱骨折5例。术前将每例患者的CT数据导入Mimics软件重建并3D打印出骨盆患侧和健侧镜像三维模型,模拟手术。所有患者均采用单一Kocher-Langenbeck入路处理髋臼后方骨折,复位满意后使用髋臼后壁后柱一体化解剖钢板固定。采用Matta的X线评估标准评价骨折复位质量,采用Matta改良的Merle D’Aubigne?-Postel评分评价髋关节功能。结果21例患者术中复位成功后置入钢板时间为15~30 min,平均20 min;手术开始至结束时间为90~300 min,平均180 min;术中出血量300~1500 ml,平均700 ml。所有患者术后切口愈合等级均为一类,无一例发生感染、医源性坐骨神经损伤等并发症。21例患者均获得随访,随访时间12~26个月,平均19个月。Matta的X线标准评价骨折复位质量,其中解剖复位16例、复位满意3例、复位不满意2例;复位满意率为90.5%(19/21)。术后3、6个月及末次随访时Matta改良Merle D’Aubigné-Postel评分分别为(13.0±2.2)分(范围9~16分)、(15.8±2.4)分(范围10~18分)、(17.0±1.8)分(范围13~18分),差异有统计学意义(F=15.38,P<0.001)。末次随访时优15例、良3例、可3例,优良率85.7%(18/21)。术后1例出现坐骨神经损伤症状,给予静脉滴注和口服神经营养药物治疗6个月后,神经症状缓解;术后1年,2例出现关节炎相关疼痛症状,口服止疼药对症治疗。随访期间无一例发生钢板断裂、螺钉松动等并发症。结论髋臼后壁后柱一体化解剖钢板可用于治疗髋臼后壁和(或)后柱骨折,术后疗效满意,功能恢复。
Objective To explore the feasibility,safety and clinical efficacy of using the self-developed acetabular posterior wall and column integrative anatomical plate to treat various types of posterior wall/column fractures.Methods Between January 2016 and January 2019,21 patients involving acetabular posterior wall and/or column were treated with the novel acetabular posterior wall and column integrative plate,the data were collected and retrospectively analyzed.There were 11 males and 10 females,with an average of 48 years old(range,18-65 years old).According to the classification of AO/OTA,there were 6 simple fractures,9 comminuted fractures,and 6 associated with joint surface compression of posterior wall;and there were 16 simple acetabular posterior wall fractures and 5 cases associated with acetabular posterior column fractures.Before operation,the CT data of each patient was collected and imported into Mimics software to reconstruct and print a 3D model of pelvis and injured and mirrored side to simulate operation.All patients were treated with a single Kocher-Langenbeck approach for posterior acetabular fractures,and fixed with the novel integrated anatomical plate after satisfactory reduction was achieved.Matta score was used to evaluate the quality of fracture reduction,and the modified Merle D'Aubigné-Postel score was adopted to evaluate functional recovery of hip joint.Results 21 patients involved in this study,the average time of plate insertion after successful reduction was 20 min(range,15-30 min);the mean time of operation was 180 min(range,90-300 min);the intraoperative mean bleeding volume was 700 ml(range,300-1500 ml).All the incisions healed by level 1 classification,and no incisions infection and sciatic nerve injury occurred.The patients included in the study have been followed up for at least one year and the imaging data was intact,the mean follow-up time was 19 month(range,12-26 month).The fracture reduction was evaluated according to the Matta score:16 cases were anatomical reduction,3 cases were satisfactory reduction,2 cases were unsatisfactory reduction,the satisfactory rate of reduction was 90.5%(19/21);the modified Merle D'Aubigné-Postel score at 3 month was 13.0±2.2(range,9-16),6 month was 15.8±2.4(range,10-18)and last follow up was 17.0±1.8(range,13-18),respectively;the difference was statistically significant(F=15.38,P<0.001).At the last follow-up,15 cases were excellent,3 cases were good and 3 cases were fair,the total excellent and good rate was 85.7%(18/21).One case developed symptoms of sciatic nerve injury after operation,but the symptoms resolved after treating with neurotrophic drug by 6 months.2 cases developed arthritis related pain after operation,receiving symptomatic treatment with oral painkillers.During the follow-up period,no complications such as plate broken and screw loosen occurred.Conclusion The use of an integrative anatomical plate for treating posterior wall/column fractures of acetabulum achieved satisfactory fixation and postoperative functional recovery.
作者
万意州
姚升
陈开放
王玉龙
曾练
黄桂雄
郭晓东
Wan Yizhou;Yao Sheng;Chen Kaifang;Wang Yulong;Zeng Lian;Huang Guixiong;Guo Xiaodong(Department of Orthopaedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2021年第19期1419-1425,共7页
Chinese Journal of Orthopaedics
基金
国家自然科学基金(81672158,81873999)
。
关键词
髋臼
骨折
骨折固定术
内
Acetabulum
Fractures,bone
Fracture fixation,internal
