CAJ | 학술논문

目的探讨真骨盆缘完整的髋臼高位前柱骨折的治疗方法.方法 2006年1月至2010年1月,治疗12例真骨盆缘完整的髋臼高位前柱骨折,男8例,女4例；年龄29～46岁,平均35.6岁；挤压伤7例,压砸伤3例,高处坠落伤2例.术前常规摄骨盆正位、闭孔斜位、髂骨斜位X线片及CT扫描.根据是否合并后壁骨折及髂骨骨折块的完整性分为单纯型5例,合并后壁型6例,粉碎型1例.5例单纯型及2例合并较小的无移位后壁型骨折者采用髂股入路行髂嵴支持钢板加髂骨前缘拉力螺钉固定；4例合并明显移位的后壁型骨折者采用前后联合入路行拉力螺钉、支持钢板固定；1例粉碎型骨折采用扩展髂股入路行钢板螺钉固定.结果12例患者均获得随访,随访时间14～37个月,平均26.7个月.术后按Matta影像学评定标准,优8例,良3例,差1；优良率为92％.无一例发生骨折不愈合及内固定断裂.末次随访按Matta改良的Merle d'Aubigne和Postel功能评分系统评分为11～18分,平均16.8分；优7例,良4例,差1例；优良率为92％.1例发生异位骨化和轻度的创伤性关节炎.结论选择合理的手术入路、解剖复位、坚强固定是治疗真骨盆缘完整的髋臼高位前柱骨折的关键.
목적 탐토진골분연완정적관구고위전주골절적치료방법.방법 2006년1월지2010년1월,치료12례진골분연완정적관구고위전주골절,남8례,녀4례；년령29～46세,평균35.6세；제압상7례,압잡상3례,고처추락상2례.술전상규섭골분정위、폐공사위、가골사위X선편급CT소묘.근거시부합병후벽골절급가골골절괴적완정성분위단순형5례,합병후벽형6례,분쇄형1례.5례단순형급2례합병교소적무이위후벽형골절자채용가고입로행가척지지강판가가골전연랍력라정고정；4례합병명현이위적후벽형골절자채용전후연합입로행랍력라정、지지강판고정；1례분쇄형골절채용확전가고입로행강판라정고정.결과12례환자균획득수방,수방시간14～37개월,평균26.7개월.술후안Matta영상학평정표준,우8례,량3례,차1；우량솔위92％.무일례발생골절불유합급내고정단렬.말차수방안Matta개량적Merle d'Aubigne화Postel공능평분계통평분위11～18분,평균16.8분；우7례,량4례,차1례；우량솔위92％.1례발생이위골화화경도적창상성관절염.결론 선택합리적수술입로、해부복위、견강고정시치료진골분연완정적관구고위전주골절적관건.
Objective To investigate the results of open reduction with internal fixation for high anterior column fracture of acetabulum with intact true pelvic brim.Methods From January 2006 to January 2010,12 patients suffered high anterior column fracture of acetabulum without involvement of true pelvic brim were identified.There were 9 males and 3 females,with the average of 35.6 years (range,29-46).The injury was caused by crush in 7 cases,smash of heavy object in 3 cases,and fall-down from height in 2 cases.These fractures were classified into three types:isolated high anterior column fracture of acetabulum without involvement of true pelvic brim,high anterior column fracture of acetabulum without involvement of true pelvic brim with posterior wall fracture of acetabulum and commminuted high anterior column fracture of acetabulum without involvement of true pelvic brim according to present and unpresent of posterior wall fracture.Five cases suffered isolated fracture and 2 cases associated smaller and nondisplacement fracture fragment of posterior wall were reduced and fixed by buttress plate of iliac crest and lag screw of anterior border of ilium through an iliofemoral approach; 4 cases with displacement posterior wall fracture of acetabulum were reduced and reconstructed by buttress plate and lag screws of through combinations of anterior and posterior approaches.One case suffered comminuted fracture were reduced and reconstructed by plates and screws of through extended iliofemoral approach.Results The mean follow-up time of all patients was 26.7 months (range,14-37months).The quality of reduction was grade as anatomical in 8 patients,imperfect in 3,poor in 1 by Matta's score system.The fracture union was uneventful.There was nonunion and loss of internal fixation.At the final follow-up,the mean score was 16.8 (range,11-18),7 cases were graded as excellent,4 good,1 fair,according to modified Merle d'Aubigne and Postel score system.Heterotopic ossification and traumatic osteoarthritis were recorded in 1 patient.Conclusion Good clinical results can be achieved by anatomical reduction and rigid fixation through optimal approach.