CAJ | 학술논문

目的评价AO微型联合重建接骨板内固定治疗髋臼后壁骨折的近期疗效.方法 2009年1月至2013年7月,运用AO微型联合重建接骨板内固定治疗髋臼后壁骨折28例,男17例,女11例,年龄18岁～65岁,平均45.8岁.受伤至手术时间为2～16 d,平均6.8 d.入院后,髋关节脱位者,立即行脱位复位及股骨髁上或胫骨结节骨牵引,术前术后常规行骨盆正位及Judet斜位X线片,髋臼CT平扫和三维重建检查.手术采用Kocher-Langenbeck入路,术中尽量保护附着于小骨折块上的软组织,对关节面有压缩骨折尽量解剖复位,必要时植骨支撑.将微型接骨板剪切成合适长度固定骨折块,在将重建接骨板压于其表面交叉固定.术后采用改良Matta标准评定髋臼复位效果,改良Merle d'Aubigné和Postel评分系统评定患髋功能.结果共28例患者,23例患者术后获得随访平均13个月,随访率为82.2％,5例外地患者术后12周因未到医院复查或电话变更而失访,失访率为17.8％.术后采用改良Matta复位标准评定髋臼复位效果:优22例,良4例,差2例,优良率为92.8％.术后6个月随访采用改良Merle d'Aubigné和Postel评分系统评定患髋功能:优15例,良5例,可2例,差1例,优良率为87.9％.1例发生股骨头坏死,3例术后18个月出现创伤性关节炎,2例患者术后6个月发现异位骨化,2例坐骨神经损伤术后3个月恢复.结论 AO微型联合重建接骨板可以对髋臼后壁骨折进行稳定可靠的内固定,能满足患者早期功能锻炼的要求,提供一种有效的内固定方法.
목적 평개AO미형연합중건접골판내고정치료관구후벽골절적근기료효.방법 2009년1월지2013년7월,운용AO미형연합중건접골판내고정치료관구후벽골절28례,남17례,녀11례,년령18세～65세,평균45.8세.수상지수술시간위2～16 d,평균6.8 d.입원후,관관절탈위자,립즉행탈위복위급고골과상혹경골결절골견인,술전술후상규행골분정위급Judet사위X선편,관구CT평소화삼유중건검사.수술채용Kocher-Langenbeck입로,술중진량보호부착우소골절괴상적연조직,대관절면유압축골절진량해부복위,필요시식골지탱.장미형접골판전절성합괄장도고정골절괴,재장중건접골판압우기표면교차고정.술후채용개량Matta표준평정관구복위효과,개량Merle d'Aubigné화Postel평분계통평정환관공능.결과 공28례환자,23례환자술후획득수방평균13개월,수방솔위82.2％,5예외지환자술후12주인미도의원복사혹전화변경이실방,실방솔위17.8％.술후채용개량Matta복위표준평정관구복위효과:우22례,량4례,차2례,우량솔위92.8％.술후6개월수방채용개량Merle d'Aubigné화Postel평분계통평정환관공능:우15례,량5례,가2례,차1례,우량솔위87.9％.1례발생고골두배사,3례술후18개월출현창상성관절염,2례환자술후6개월발현이위골화,2례좌골신경손상술후3개월회복.결론 AO미형연합중건접골판가이대관구후벽골절진행은정가고적내고정,능만족환자조기공능단련적요구,제공일충유효적내고정방법.
Objective To evaluate the recent clinical outcomes of fixing posterior acetabular wall fractures combining the AO mini plate with reconstruction plate.Methods From Jan 2009 to Jul 2013,28 patients with posterior acetabular wall fracture were fixed by the AO mini-steel plate combined with reconstruction plate,including 17males and 11 females with the mean age of 45.8 years (range,18-65).After admission,reduce the dislocation of hip joint immediately,and take femoral condyle or tibial tubercle traction.Preoperative and postoperative anteroposterior and Judet oblique radiographs,acetabular CT scan and three-dimensional reconstruction imaging were routine taken.Using Kocher-Langenbeck approach,intraoperative,try to protect the soft tissue attached on the small fragments,and reduct the fracture.Cutting the mini plate into proper length with reconstruction plate fix to its surface crossover.The functional outcomes were evaluated by the modified Merle d'Aubigné and Postel clinical grading system.The radiographs were graded according to the Matta/Judet criteria.Results Twenty-three patients are followed up 13 months(82.2％),and 5 cases lost in 12 weeks (17.8％).By the Matta/Judet criteria,22 cases achieved excellent reduction,4 good reduction and two fair reduction,with a good and excellent rate of 92.8％.By the modified Merle d'Aubigné and Postel criteria,functional recovery of the affected hip six month post-operation was rated as excellent in 15 cases,good in 5 cases,fair in 2 cases and poor in one case.with a good and excellent rate of 87.9％.One case occurred femoral head necrosis.In 2 patients 2 years after surgery developed traumatic arthritis.Two patients had heterotopic ossification after six month operation.One patient with injury to the sciatic nerve recovered 3 months post-operation.Conclusion Using the AO mini plate combined with reconstruction plate can fix the acetabular posterior wall fractures stably.The technique meet the requirements of patients with early functional exercise,which provides an effective method of internal fixation.