摘要
[目的]探讨动力化前路方形区钛板螺钉系统(DAPSQ)内固定治疗伴髋臼顶骨折的复杂性髋臼骨折的手术技巧及临床疗效。[方法]回顾性分析2009年6月～2016年9月手术治疗的66例伴髋臼顶骨折的复杂性髋臼骨折患者资料,男44例,女22例,平均年龄(46.63±10.52)岁。按Letournel-Judet分型:双柱骨折33例,前柱伴后半横行骨折12例,前柱骨折9例, T型骨折12例。所有臼顶骨折病例均采用单一髂腹股沟入路开窗+截骨行DAPSQ内固定治疗,需要时联合骨盆前缘短钢板固定。[结果]所有患者顺利手术,手术时间(182.50±56.28) min;术中出血量(550.35±102.94) ml。4例患者术后股外侧麻木,1～4个月症状消失。随访12～46个月,平均(30.36±10.23)个月。随术后时间延长VAS评分减少,而Harris评分和Merle d’Aubigne-Postel评分显著增加(P<0.05)。影像评估方面:依据Matta标准,骨折复位评定为优35例,良好20例,一般7例,差4例。3例出现Brooker I型异位骨化,6例出现创伤性骨关节炎改变。末次随访时,3例改行全髋关节置换。[结论]单一髂腹股沟入路联合开窗、截骨为臼顶骨折复位提高良好的术野,DAPSQ内固定能够固定和维持髋臼顶的解剖位置,恢复头臼匹配关系,从而保留髋关节的功能,临床疗效良好。
[Objective]To investigate the surgical technique and clinical outcomes of dynamic anterior plate-screw System for quadrilateral area(DAPSQ)of complex acetabular fractures involving the dome.[Methods]A retrospective study was conducted on 66 patients who underwent surgical treatment for complex acetabular fractures involving the dome between June 2009 and September 2016,including 44 males and 22 females aged(46.63±10.52)years on average.According to Letournel-Judet classification,33 patients were of double-column fractures,12 of anterior column accompanied by posterior hemitransverse fractures,9 of anterior column fractures,and 12 of T-type fractures.All patients had acetabular fractures involving the dome treated by open reduction and internal fixation(ORIF)with DAPSQ through single ilioinguinal approach combined with fenestration plus osteotomy,and anterior pelvic short plate was added if necessary.[Results]All the 66 patients had operation performed smoothly with operation time of(182.50±56.28)min and intraoperative blood loss of(550.35±102.94)ml.Of them,4 patients had lateral femoral numbness after operation,which subsided in 1-4 months.The follow-up period lasted for 12-46 months with an average of(30.36±10.23)months.The VAS score decreased over time,while Harris score and Merle d’Aubigne-Postel score increased significantly(P<0.05).In terms of imaging evaluation,according to the Matta standard,fracture reduction was assessed as excellent in 35 cases,good in 20 cases,fair in 7 cases and poor in 4 cases.Brooker I type heterotopic ossification occurred in 3 patients and traumatic osteoarthritis in 6 patients.At the last follow-up,3 patients underwent total hip replacement.[Conclusion]This single ilioinguinal approach combined with fenestration plus osteotomy provides proper visual field for anatomic reduction of complex acetabular fracture involving the dome,while internal fixation with DAPSQ does effectively maintain the anatomic position of the acetabular dome to restore head-acetabular congruence,which
作者
陈岩召
蔡贤华
吴海洋
CHEN Yan-zhao;CAI Xian-hua;WU Hai-yang(Hubei Orthopaedic Traumatology Center,Orthopaedic Department,Central Theater Command General Hospi?tal of the Chinese People's Liberation Army,Wuhan430070,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第8期697-701,共5页
Orthopedic Journal of China
基金
湖北省技术创新专项项目(重大项目)(编号:2017ACA099)
关键词
髋臼骨折
髋臼顶
髂腹股沟入路
开窗术
方形区钛板螺钉系统
acetabular fracture
acetabular dome
ilioinguinal approach
fenestration
plate-screw system for quadrilateral area
