前路接骨板联合单枚和多枚后柱螺钉治疗髋臼双柱骨折的疗效比较

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摘要目的观察比较前入路预塑形接骨板联合单枚和多枚后柱螺钉治疗髋臼双柱骨折的临床疗效。方法回顾性分析比较2016年1月至2022年6月南华大学衡阳医学院附属郴州医院采用前入路预塑形接骨板联合单枚和多枚后柱螺钉治疗的33例髋臼双柱骨折患者，男23例，女10例；年龄18～72岁，平均(49.8±14.2)岁。术前利用3D打印骨盆模型预塑形接骨板。单枚后柱螺钉固定组14例，多枚后柱螺钉组19例。采用Matta标准评估髋臼骨折复位质量，采用改良的Merle D’Aubigne和Postel评分系统评估髋关节功能。结果所有患者均获随访，随访时间8～34个月，平均(10.3±4.5)个月。骨折均愈合。多枚后柱螺钉组手术时间、术中出血量、透视时间显著高于单枚后柱螺钉组(P＜0.05)，两组间骨折愈合时间比较，差异无统计学意义(P＞0.05)。术后骨折复位质量：单枚后柱螺钉组优3例，良9例，差2例，优良率85.7%；多枚后柱螺钉组优13例，良5例，差1例，优良率94.7%；两组优良率比较差异无统计学意义(P＞0.05)，但多枚后柱螺钉组解剖复位率明显高于单枚后柱螺钉组，差异有统计学意义(P＜0.05)。髋关节功能评估：单枚后柱螺钉组优4例，良8例，可2例，优良率85.7%；多枚后柱螺钉组优7例，良9例，可3例，优良率84.2%，两组优良率比较差异无统计学意义(P＞0.05)。结论前入路预塑形接骨板联合单枚和多枚后柱螺钉治疗髋臼双柱骨折均可获得满意疗效，多枚后柱螺钉具有更好的复位固定作用。

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	王朝晖
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	唐艳平
	张亮

关键词 ：髋臼双柱骨折, 后柱螺钉, 手术入路

Abstract：

Objective To compare the clinical results of pre-contoured plates combined with single and multiple antegrade posterior column screw via anterior approach for treatment of both columns acetabular fractures.Methods A retrospective analysis was performed on 33 patients with both columns acetabular fractures treated with pre-contoured plates combine single and multiple antegrade posterior column screw via anterior approach from Jan 2016 to Jun 2022.There were 23 males and 10 females，with an average of (49.8±14.2) years (range，18 to 72 years).Preoperative 3D printing of pelvic model and pre-contoured plates were applied.There were 14 cases in simple posterior column screw group and 19 cases in multiple posterior column screws group.The fracture reduction was assessed with Matta scoring system，and the hip function was evaluated with modified Merle D’Aubigne and Postel scoring system.Results All cases were followed up for 8 to 34 months with an average of (10.3±4.5) months.The acetabular fractures all healed.The operation time，intraoperative blood loss and fluoroscopy time in multiple posterior column screws group were significantly higher than simple posterior column screw group (P＜0.05).No significant difference was found in fracture site healing time between the two groups (P＞0.05).Fracture reduction quality was excellent in 3 cases，good in 9 cases，pool in 2 cases，the excellent and good rate was 85.7% in simple posterior column screw group，and it was excellent in 13 cases，good in 5 cases，poor in 1 case，the excellent and good rate was 94.7% in multiple posterior column screw group.No significant difference was found between the excellent and good rate of fracture reduction (P＞0.05)，but the rate of anatomical reduction in multiple posterior column screw group was significantly higher than simple posterior column screw group (P＜0.05).The hip function was excellent in 4 cases，good in 8 cases，fair in 2 cases，the excellent and good rate was 85.7% in simple posterior column screw group，and excellent in 7 cases，good in 9 cases，fair in 3 case，the excellent and good rate was 84.2% in multiple posterior column screw group.No significant difference was found between the two groups (P＞0.05).Conclusion Pre contoured plates combined with single and multiple posterior column screw via anteriopr approach for treatment of two-columns acetabular fracture have good clinical effecacy.Multiple posterior column screws can get better reduction and fixation.

Key words： two-columns acetabular fracture posterior column screw surgical approach

基金资助:湖南省卫生健康委科研项目(202104070593)

作者简介: 王朝晖(1970－ )，男，主任医师，南华大学衡阳医学院附属郴州医院创伤骨科，wxsy1997@163.com

引用本文:

王朝晖，曹书杰，刘建伟，赵快平，唐艳平，张亮. 前路接骨板联合单枚和多枚后柱螺钉治疗髋臼双柱骨折的疗效比较[J]. 实用骨科杂志, 2023, 29(8): 673-.
Wang Zhaohui，Cao Shujie，Liu Jianwei，Zhao Kuaiping，Tang Yanping，Zhang Liang. Comparison Plates With Single and Multiple Posterior Column Screw through Anterior Approach in the Treatment of Both Columns Acetabular Fractures. sygkzz, 2023, 29(8): 673-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2023/V29/I8/673

［1］G-nsslen A，Frink M，Hildebrand F，et al.Both column fractures of the acetabulum：epidemiology，operative management and longtermresults［J］.Acta Chir Orthop Traumatol Cech，2012，79(2)：107-113.
［2］Yang Y，Tang TT，Zou C，et al.Clinical outcomes of the modified Stoppa combined with iliac fossa approach for complex acetabular fractures：A medium and long term retrospective study［J］.Orthop Surg，2022，14(9)：1998-2005.
［3］Wu H，Shang R，Cai X，et al.Single ilioinguinal approach to treat complex acetabular fractures with quadrilateral plate involvement：Outcomes using a novel dynamic anterior platescrew system［J］.Orthop Surg，2020，12(2)：488-497.
［4］Wenzel L，von Rüden C，Thannheimer A，et al.The pararectus approach in acetabular surgery：Radiological and clinical outcome［J］.J Orthop Trauma，2020，34(2)：82-88.
［5］Huang JH，Liao H，Tan XY，et al.Surgical treatment for both column acetabular fractures using pre-operative virtual simulation and three-dimensional printing techniques［J］.Chin Med J (Engl)，2020，133(4)：395-401.
［6］Zou R，Wu M，Guan J，et al.Therapeutic effect of acetabular fractures using the pararectus approach combined with 3D printing technique［J］.Orthop Surg，2020，12(6)：1854-1858.
［7］ Pierannunzii L，Fischer F，Tagliabue L，et al.Acetabular both-column fractures：Essentials of operative management［J］.Injury，2010，41(11)：1145-1149.
［8］G-nsslen A，Krettek C.Internal fixation of acetabular bothcolumn fractures via the ilioinguinal approach［J］.Oper Orthop Traumatol，2009，21(3)：270-282.
［9］杨杰，王朝晖，何波涌，等.3D打印技术辅助髂腹股沟入路治疗髋臼双柱骨折［J］.实用骨科杂志，2020，26(3)：206-209.
［10］Matta JM.Operative treatment of acetabular fractures through the ilioinguinal approach：A 10-year perspective［J］.J Orthop Trauma，2006，20(1Suppl)：S20-29.
［11］Hinz N，Dehoust J，Münch M，et al.Biomechanical analysis of fxation methods in acetabular fractures：A systematic review of test setups［J］.Eur J Trauma Emerg Surg，2022，48(5)：3541-3560.
［12］Giordano V，Acharya MR，Pires RE，et al.Associated both-column acetabular fracture：An overview of operative steps and surgical technique［J］.J Clin Orthop Trauma，2020，11(6)：1031-1038.
［13］Pohlemann T，Herath SC，Braun BJ，et al.Anterior approaches to the acetabulum：Which one to choose?［J］.EFORT Open Rev，2020，5(10)：707-712.
［14］曹奇勇，吴宏华，孙旭，等.腹直肌旁入路与髂腹股沟入路内固定治疗髋臼骨折围手术期结果的前瞻性随机对照研究［J］.中华创伤骨科杂志，2021，23(6)：513-518.
［15］李亚光，张元智，史志强，等.髋臼后柱顺行螺钉固定钉道的有限元分析［J］.中国矫形外科杂志，2021，29(3)：249-253.
［16］曹烈虎，周启荣，翁蔚宗，等.前柱钢板联合后柱拉力螺钉固定复杂髋臼骨折的生物力学研究［J］.第二军医大学学报，2017，38(11)：1397-1402.
［17］Le Quang H，Schmoelz W，Lindtner RA，et al.Single column plate plus other column lag screw fxation vs.both column plate fxation for anterior column with posterior hemitransverse acetabular fractures：A biomechanical analysis using diferent loading protocols［J］.Injury，2021，52(4)：699-704.
［18］黄进成，刘曦明，蔡贤华，等.前路钛板加方形区螺钉联合后柱螺钉治疗髋臼双柱骨折的有限元分析［J］.中国矫形外科杂志，2014，22(14)：1104-1110.
［19］Wu H，Shao Q，Song C，et al.Personalized three-dimensional printed anterior titanium plate to treat double-column acetabular fractures：A retrospective case-control study［J］.Orthop Surg，2020，12(4)：1212-1222.