前路钢板螺钉内固定治疗髋臼骨折伴骶髂关节脱位的疗效分析

目的探讨前路钢板螺钉内固定治疗髋臼骨折伴骶髂关节脱位的临床疗效。方法回顾性分析自2011-01—2015-12采用髂腹股沟入路切开复位骨盆重建接骨板加骶髂关节星形接骨板内固定治疗的24例髋臼骨折伴骶髂关节脱位。髋臼骨折复位质量按Matta复位评分标准评定。骶髂关节分离复位评定采用PACS系统分别对术前及术后的CT横断面及矢状面骶髂关节间隙最宽处进行测量。髋关节功能采用Majeed评分标准评定。结果术前CT横断面骶髂关节间隙为(11.86±3.43)mm,术后为(4.05±0.76)mm,手术前后差值为(7.58±2.87)mm;术前CT矢状面骶髂关节间隙为(16.29±3.84)mm,术后为(4.27±0.95)mm,手术前后差值为(11.83±3.19)mm;结果显示术后髋臼及骶髂关节脱位复位良好。24例均获得随访7~30个月,平均12.8个月。骨折愈合时间3~9个月,平均4.8个月。髋臼骨折复位质量按Matta标准评定:优13例,良8例,可3例,优良率为87.5%。髋关节功能采用Majeed评分标准评定:优7例,良11例,可5例,差1例,优良率为75.0%。结论前侧髂腹股沟入路骨盆重建接骨板加骶髂关节星形接骨板内固定治疗髋臼骨折伴骶髂关节脱位是一种简单有效的方法,具有操作安全、骨折复位满意、术后疗效肯定的优点。

Clinical analysis of anterior bone plate fixation for acetabular fractures and sacroiliac joint dislocation

Objective To explore the clinical effects of anterior bone plate fixation for acetabular fractures and sacroiliac joint dislocation.Methods Twenty-four patients with acetabular fractures and sacroiliac joint dislocation who were treated with anterior open reduction,and internal fixation with pelvis reconstruction plate and sacroiliac joint plate were respectively analyzed.Acetabular fractures reductions were evaluated according to the Matta score system.Sacroiliac joint dislocation reductions were evaluated according to the difference between the widest sacroiliac joint gap before and after the operation in cross-sectional and sagittal-sectional of CT with PACS,and the hip joint function were evaluated according to the Majeed score system.Results The sacroiliac joint gap before and after the operation in cross-sectional of CT was (11.86±3.43)mm and (4.05±0.76)mm,the difference value was (7.58±2.87)mm,and in sagittal-sectional of CT were (16.29±3.84)mm and (4.27± 0.95)mm,the difference value was (11.83±3.19)mm.The result displayed that the reductions of acetabular fractures and sacroiliac joint dislocation were satisfactory after the operation.All of 24 cases were followed up for 7-30 months (mean 12.8 months) after operation.The bone healing time were 3-9 months (mean 4.8 months).The reductions of acetabular fractures which were measured by Matta score:13 excellent cases,8 good cases,3 fair cases;the excellent and good rate was 87.5％.The hip joint functions which were measured by Majeed score:7 excellent cases,11 good cases,5 fair cases,and 1 poor case;the excellent and good rate was 75.0％.Conclusion The anterior open reduction by ilioinguinal approach,pelvis reconstruction plate and sacroiliac joint plate internal fixation for acetabular fractures and sacroiliac joint dislocation are satisfactory with safe operation,satistactory reduction and affirmative curative effect.