髋臼前后柱拉力螺钉结合重建钢板固定治疗髋臼横断骨折

目的回顾分析髋臼前后柱螺钉结合重建钢板固定治疗髋臼横断骨折的疗效。方法本组患者共36例,采用Kochher-Langenback入路14例,髂腹股沟入路12例,扩展型髂股入路6例,前后联合入路4例。本组病例中采用后路重建钢板结合前柱螺钉固定21例,前路重建钢板结合后柱螺钉固定15例。结果随访时间6~27个月,平均19.6个月。复位评估参照Matta标准,解剖复位22例（61.11%）;满意复位10例（27.78%）;复位不满意4例（11.11%）。关节功能按改良Merled Aubigne6分法和Epstein标准评定,优23例（63.89%）,良8例（22.22%）,可3例（8.33%）,差2例（5.56%）,优良率86.11%。异位骨化4例,按Brooker分级：Ⅰ-Ⅱ级3例,Ⅲ~Ⅳ级1例。深静脉栓塞2例,经非手术治疗而愈,坐骨神经医源性损伤1例,经治疗6月后恢复,股骨头坏死3例。结论髋臼前后柱螺钉固定结合钛板治疗髋臼横断骨折,创伤较少,固定坚强,治疗效果良好。

Internal fixation with lag screw for anterior or posterior column of the acetabulum and reconstruction plate in transverse acetabular fracture

Objective To analyse the outcome of internal fixation with lag screw for anterior or posterior column of the acetabulum and reconstruction plate in transverse acetabular fracture retrospectively. Methods Thirty-six cases of transverse acetabular fractures were treated with open reduction and internal fixation. Kocher-Langenbeck approach were adopted in 14 cases, the ilioinguinal approach in 12 cases, extended iliofemoral approach in 6 case, combination with anterior and posterior approach in 4 cases. 21 patients were fixed by posterior reconstruction plate combined with anterior lag screws, the others were fixed with anterior reconstruction plate combined with posterior lag screws. Results The average follow-up time was 19.6 months with range from 6 months to 32 months. According to Matta standard, anatomy reduction were obtained in 22 cases （61.11%）, satisfactory reduction 10 cases （27.78%）,unsatisfactory 6 cases （11.11%）. Based on Merled Aubigne and Epstein standard assessment, 23 patients achieved excellent results （63.89%）, good 8 （22.22%）,fair 3 （8.33%）,poor 2 （5.56%）. Excellent and good rates was 86.11%. Heterotopic ossification occurred in 4 cases, in which Brooker grade I～II were 3 cases , III~IV 1 cases. There were deep vein thrombus in 2 cases, Sciatic nerve injury was seen in 1 cases and was recovered 6 months later, They were all further treated by conservative treatments. Avascular necrosis of the femoral head was found in 3 cases. Conclusion It shows that the transverse acetabular fractures treated by the combination of anterior or posterior lag screw and Ti-plate is less invasive and more strong as well. The clinical results are also excellent.