中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2014年
2期
110-114
,共5页
刘曦明%黄进成%蔡贤华%汪国栋%王华松%潘昌武
劉晞明%黃進成%蔡賢華%汪國棟%王華鬆%潘昌武
류희명%황진성%채현화%왕국동%왕화송%반창무
髋臼%骨折%骨折固定术,内%骨钉%骨板
髖臼%骨摺%骨摺固定術,內%骨釘%骨闆
관구%골절%골절고정술,내%골정%골판
Acetabulum%Fractures,bone%Fracture fixation,internal%Bone nails%Bone plates
目的 探讨前路钛板加方形区螺钉联合改良后柱拉力螺钉内固定治疗涉及方形区的复杂髋臼骨折的临床疗效. 方法 回顾性分析2010年3月至2013年1月收治的21例涉及方形区的髋臼骨折患者资料,男13例,女8例;年龄为19～ 65岁,平均41.2岁.骨折按Letournel分型:双柱骨折11例,T形骨折5例,前柱伴后半横形骨折5例.受伤至手术时间为4～16d,平均6.5d.所有患者均采用单一髂腹股沟入路,用钛板加方形区螺钉联合改良后柱拉力螺钉进行内固定. 结果 本组患者手术时间为120 ～270 min,平均190 min;术中出血量为300～1 800 mL,平均540 mL.根据改良Matta髋臼骨折复位标准评定骨折复位质量:解剖复位14例,满意复位6例,不满意复位1例.21例患者术后获平均21.4个月(6～38个月)随访.末次随访时根据改良的Merle d'Aubigné-Postel功能评分标准评定患髋功能:优12例,良5例,可3例,差1例,优良率为81.0％.本组患者并发症发生率为23.8％(5/21),其中股外侧皮神经麻痹2例,异位骨化1例,创伤性关节炎2例. 结论 前路钛板加方形区螺钉联合改良后柱拉力螺钉治疗涉及方形区的双柱骨折、T形骨折及前柱伴后半横形骨折具有创伤小、固定可靠、并发症发生率低等优点,临床效果良好,是治疗此类髋臼骨折的一种可行方法.
目的 探討前路鈦闆加方形區螺釘聯閤改良後柱拉力螺釘內固定治療涉及方形區的複雜髖臼骨摺的臨床療效. 方法 迴顧性分析2010年3月至2013年1月收治的21例涉及方形區的髖臼骨摺患者資料,男13例,女8例;年齡為19～ 65歲,平均41.2歲.骨摺按Letournel分型:雙柱骨摺11例,T形骨摺5例,前柱伴後半橫形骨摺5例.受傷至手術時間為4～16d,平均6.5d.所有患者均採用單一髂腹股溝入路,用鈦闆加方形區螺釘聯閤改良後柱拉力螺釘進行內固定. 結果 本組患者手術時間為120 ～270 min,平均190 min;術中齣血量為300～1 800 mL,平均540 mL.根據改良Matta髖臼骨摺複位標準評定骨摺複位質量:解剖複位14例,滿意複位6例,不滿意複位1例.21例患者術後穫平均21.4箇月(6～38箇月)隨訪.末次隨訪時根據改良的Merle d'Aubigné-Postel功能評分標準評定患髖功能:優12例,良5例,可3例,差1例,優良率為81.0％.本組患者併髮癥髮生率為23.8％(5/21),其中股外側皮神經痳痺2例,異位骨化1例,創傷性關節炎2例. 結論 前路鈦闆加方形區螺釘聯閤改良後柱拉力螺釘治療涉及方形區的雙柱骨摺、T形骨摺及前柱伴後半橫形骨摺具有創傷小、固定可靠、併髮癥髮生率低等優點,臨床效果良好,是治療此類髖臼骨摺的一種可行方法.
목적 탐토전로태판가방형구라정연합개량후주랍력라정내고정치료섭급방형구적복잡관구골절적림상료효. 방법 회고성분석2010년3월지2013년1월수치적21례섭급방형구적관구골절환자자료,남13례,녀8례;년령위19～ 65세,평균41.2세.골절안Letournel분형:쌍주골절11례,T형골절5례,전주반후반횡형골절5례.수상지수술시간위4～16d,평균6.5d.소유환자균채용단일가복고구입로,용태판가방형구라정연합개량후주랍력라정진행내고정. 결과 본조환자수술시간위120 ～270 min,평균190 min;술중출혈량위300～1 800 mL,평균540 mL.근거개량Matta관구골절복위표준평정골절복위질량:해부복위14례,만의복위6례,불만의복위1례.21례환자술후획평균21.4개월(6～38개월)수방.말차수방시근거개량적Merle d'Aubigné-Postel공능평분표준평정환관공능:우12례,량5례,가3례,차1례,우량솔위81.0％.본조환자병발증발생솔위23.8％(5/21),기중고외측피신경마비2례,이위골화1례,창상성관절염2례. 결론 전로태판가방형구라정연합개량후주랍력라정치료섭급방형구적쌍주골절、T형골절급전주반후반횡형골절구유창상소、고정가고、병발증발생솔저등우점,림상효과량호,시치료차류관구골절적일충가행방법.
Objective To summarize our clinical experience in the treatment of complex quadrilateral fractures of the acetabulum with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws.Methods From March 2010 to January 2013,21 cases of quadrilateral fractures of the acetabulum were treated in our department.They were 13 males and 8 females,aged from 19 to 65 years (average,41.2 years).According to the Letournel classification,there were 11 double-column fractures,5 T-shaped ones and 5 anterior column plus posterior hemi-transverse ones.The average time from injury to operation was 6.5 days (from 4 to 16 days).All cases were treated via the ilioinguinal approach with internal fixation with reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws.Results The operation time for this series ranged from 120 to 270 minutes,averaging 190 minutes.The intraoperative blood bleeding ranged from 300 to 1 800 mL,with an average of 540 mL.By the modified Matta evaluation system,14 cases had anatomic reduction,6 cases satisfactory reduction,and one dissatisfactory reduction.The 21 patients were followed up from 6 to 38 months (average,21.4 months).According to the improved Merled' Aubigné-Postel criteria at the last follow-up,12 cases were rated as excellent,5 good,fair 3 cases,and one poor,giving an excellent-to-good rate of 81.0 ％.The complication rate for this series was 23.8％ (5/21),including 2 cases of lateral femoral cutaneous nerve injury,one case of heterotopic ossification and 2 cases of traumatic arthritis.Conclusion In the treatment of quadrilateral fractures of double columns,T-shaped fractures and anterior column plus posterior hemi-transverse fractures,internal fixation with anterior reconstruction titanium plate plus trans-plate quadrilateral screws and improved posterior column lag screws is really an optimal choice,because it can lead to limited invasion,rigid fixation,fewer complications,and satisfactory outcomes.
