CAJ | 학술논문

目的比较髋臼后壁骨折手术治疗中2种钢板固定位置的临床疗效,探讨髋臼后壁骨折钢板的最佳固定位置.方法回顾性分析2004年5月至2014年1月采用拉力螺钉结合重建钢板固定治疗的58例髋臼后壁骨折患者资料,男46例,女12例;年龄为20～67岁;左侧27例,右侧31例;受伤至手术时间为1～19d,平均7.1d.髋臼骨折按Letournel-Judet分型均属于后壁骨折.58例患者均采用Kocher-Langenbeck入路3.5 mm重建钢板和拉力螺钉复位、固定骨折.根据钢板与螺钉固定位置不同分为2组:A组25例,钢板位于螺钉后方、远离臼缘;B组33例,钢板位于螺钉前方、靠近臼缘.比较两组患者的骨折复位质量、骨折愈合时间、并发症发生情况及功能结果. 结果 58例患者术后获平均2.3年(1～5年)随访.术后骨折复位质量采用改良Matta评分标准评定:均获解剖复位.A、B组患者的骨折愈合时间平均分别为(14.8±3.5)、(14.6±3.4)周,差异无统计学意义(t=0.073,P=0.788).末次随访时根据改良Merle d'Aubigné和Postel评分系统评定患髋功能:A组优8例,良11例,可4例,差2例,优良率为76.0％;B组优11例,良17例,可4例,差1例,优良率为84.8％,两组比较差异有统计学意义(x2=4.581,P=0.032).A组患者术后并发症发生率(32.0％,8/25)显著高于B组患者(9.1％,3/33),差异有统计学意义(x2=5.926,P=0.015). 结论髋臼后壁骨折使用重建钢板固定,钢板应尽量靠近髋臼前缘,在该位置钢板能提供更为牢靠和稳定的固定.
목적 비교관구후벽골절수술치료중2충강판고정위치적림상료효,탐토관구후벽골절강판적최가고정위치.방법 회고성분석2004년5월지2014년1월채용랍력라정결합중건강판고정치료적58례관구후벽골절환자자료,남46례,녀12례;년령위20～67세;좌측27례,우측31례;수상지수술시간위1～19d,평균7.1d.관구골절안Letournel-Judet분형균속우후벽골절.58례환자균채용Kocher-Langenbeck입로3.5 mm중건강판화랍력라정복위、고정골절.근거강판여라정고정위치불동분위2조:A조25례,강판위우라정후방、원리구연;B조33례,강판위우라정전방、고근구연.비교량조환자적골절복위질량、골절유합시간、병발증발생정황급공능결과. 결과 58례환자술후획평균2.3년(1～5년)수방.술후골절복위질량채용개량Matta평분표준평정:균획해부복위.A、B조환자적골절유합시간평균분별위(14.8±3.5)、(14.6±3.4)주,차이무통계학의의(t=0.073,P=0.788).말차수방시근거개량Merle d'Aubigné화Postel평분계통평정환관공능:A조우8례,량11례,가4례,차2례,우량솔위76.0％;B조우11례,량17례,가4례,차1례,우량솔위84.8％,량조비교차이유통계학의의(x2=4.581,P=0.032).A조환자술후병발증발생솔(32.0％,8/25)현저고우B조환자(9.1％,3/33),차이유통계학의의(x2=5.926,P=0.015). 결론 관구후벽골절사용중건강판고정,강판응진량고근관구전연,재해위치강판능제공경위뢰고화은정적고정.
Objective To analyze the optimal position of reconstructive plate in the operative treatment of acetabular posterior wall fractures by comparing 2 plate placements.Methods From May 2004 to January 2014,58 patients with acetabular posterior wall fracture according to Letournel-Judet classification were treated at our department.They were 46 men and 12 women,aged from 20 to 67 years.The fracture affected the left side in 27 cases and the right side in 31 ones.The time from injury to surgery ranged from 1 to 19 days.Their reduction and fixation were conducted with a 3.5 mm reconstructive plate and lag screws via the Kocher-Langenbeck approach.They were divided into 2 groups according to the positions of the plate and the screws.In group A of 25 cases,screws were placed behind the plate,far from the acetabular rim.In group B of 33 cases,screws were placed ahead of the plate,close to the acetabular rim.The 2 groups were compared in terms of reduction,fracture healing time,complications,and functional recovery.Results The 58 patients were followed up for an average of 2.3 years (range,from 1 to 5 years).According to the modified Matta criteria,anatomic reduction was achieved in all the patients.Fracture healing time averaged 14.8 ± 3.5 weeks in group A and 14.6 ± 3.4 weeks in group B,showing no statistically significant difference(t =0.073,P=0.788).According to the modified Merle d'Aubigné & Postel criteria,the hip function was excellent in 8 cases,good in 11,fair in 4,and poor in 2 in group A,giving an excellent to good rate of 76.0％;the hip function was excellent in 11 cases,good in 17,fair in 4,and poor in one in group B,giving an excellent to good rate of 84.8％.There was a significant difference between the 2 groups (x2 =4.581,P =0.032).The incidence of complications in group A (32.0％,8/25) was significantly higher than in group B (9.1％,3/33) (x2 =5.926,P =0.015).Conclusion In treatment of acetabular posterior wall fractures,the pelvic reconstructive plate should be placed as close as possible to the acetabular rim because the plate at this position can provide stronger and more stable fixation.