CAJ | 학술논문

目的探讨前路钛板结合方形区螺钉内固定治疗涉及方形区的髋臼骨折的疗效. 方法 2005年1月至2011年5月共收治52例涉及方形区的髋臼骨折患者,其中36例获得随访,男21例,女15例；年龄21～59岁,平均43.5岁.骨折按Letournel分型:双柱骨折15例,横形骨折4例,前柱伴后半横形骨折8例,T形骨折9例.所有患者均采用髂腹股沟入路,复位后行重建钛板及经钛板3 ～5枚皮质骨螺钉(方形区螺钉)部分经骨表面内固定.术后应用Matta放射学标准评估骨折复位质量,末次随访时采用改良Merle d'Aubigné和Postel评分标准评定髋关节功能. 结果 36例患者术后获12 ～ 72个月(平均41.7个月)随访.术后骨折复位质量按Matta放射学标准评定:解剖复位19例,良好复位12例,不满意复位5例,复位优良率为86.1％.所有患者骨折均获临床愈合,愈合时间为2～4个月,平均3个月.末次随访时采用改良Merle d'Aubigné和Postel评分标准评定髋关节功能:优16例,良13例,可5例,差2例,优良率为80.6％.本组患者功能优良率与骨折复位质量呈明显正相关(r=0.513,P=0.001).无一例患者发生方形区螺钉松脱、断裂.结论前路钛板结合方形区螺钉内固定可靠,无进入髋关节腔之虞,是治疗以前柱损伤为主的双柱骨折、向前移位的横形骨折、部分前柱合并后半横形骨折及部分T形骨折的有效方法之一.
목적 탐토전로태판결합방형구라정내고정치료섭급방형구적관구골절적료효. 방법 2005년1월지2011년5월공수치52례섭급방형구적관구골절환자,기중36례획득수방,남21례,녀15례；년령21～59세,평균43.5세.골절안Letournel분형:쌍주골절15례,횡형골절4례,전주반후반횡형골절8례,T형골절9례.소유환자균채용가복고구입로,복위후행중건태판급경태판3 ～5매피질골라정(방형구라정)부분경골표면내고정.술후응용Matta방사학표준평고골절복위질량,말차수방시채용개량Merle d'Aubigné화Postel평분표준평정관관절공능. 결과 36례환자술후획12 ～ 72개월(평균41.7개월)수방.술후골절복위질량안Matta방사학표준평정:해부복위19례,량호복위12례,불만의복위5례,복위우량솔위86.1％.소유환자골절균획림상유합,유합시간위2～4개월,평균3개월.말차수방시채용개량Merle d'Aubigné화Postel평분표준평정관관절공능:우16례,량13례,가5례,차2례,우량솔위80.6％.본조환자공능우량솔여골절복위질량정명현정상관(r=0.513,P=0.001).무일례환자발생방형구라정송탈、단렬.결론 전로태판결합방형구라정내고정가고,무진입관관절강지우,시치료이전주손상위주적쌍주골절、향전이위적횡형골절、부분전주합병후반횡형골절급부분T형골절적유효방법지일.
Objective To explore the clinical efficacy of internal fixation using reconstruction titanium plate combined with trans-plate quadrilateral screws in treatment of quadrilateral plate fractures of the acetabulum via the ilioinguinal approach.Methods Of the 52 quadrilateral plate fractures of the acetabulum which had been treated between January 2005 and May 2011,36 cases were followed up.They were 21 males and 15 females,with an average age of 43.5 years (from 21 to 59 years).By Letournel's classification,there were 15 double-column fractures,4 transverse ones,8 anterior column plus posterior hemi-transverse ones and 9 T-shaped ones.All the fractures were treated with internal fixation using reconstruction titanium plate combined with 3 to 5 trans-plate cortical screws (so-called quadrilateral screws) via the ilioinguinal approach after the fracture reduction.In some,fixation was conducted via the bone surface.The quality of reduction was evaluated using the Matta's radiologic scoring system whilst the hip functional recovery using the modified Merle d'Aubigné and Postel scoring system.Results The duration of follow-up was 12 to 72 months (average,41.7 months).Nineteen patients achieved anatomical reduction,12 patients functional reduction and 5 patients dissatisfactory reduction,giving an excellent and good rate of 86.1％.All the patients achieved fracture healing after 2 to 4 months (average,3 months).In terms of functional recovery,16 patients were rated as excellent,13 as good,5 as acceptable and 2 as poor,giving an excellent and good rate of 80.6％.The rate of excellent and good recovery was positively related to the quality of the fracture reduction (r=0.513,P=0.001).No loosening or breaking of screws happened at the follow-ups.Conclusion Internal fixation using reconstruction titanium plate combined with trans-plate quadrilateral screws via ilioinguinal approach is an effective choice for treatment of double-column fractures chiefly involving the anterior column,transverse factures with anterior displacement,some anterior column plus posterior hemi-transverse fractures and some T-shaped fractures because there is no risk of screws penetrating into the joint cavity.