摘要
目的探讨髋臼顶压缩性骨折的形态学特点及其对手术治疗的意义。方法回顾性分析2014年1月至2018年1月期间西安市红会医院骨创伤医院环骨盆病区收治的22例髋臼顶压缩性骨折患者资料。男14例,女8例;平均年龄为58.9岁(30~85岁)。骨折按Letournel-Judet分型:前柱骨折1例,后柱+后壁骨折1例,横形骨折1例,前方+后半横形骨折13例,双柱骨折2例,T形骨折1例,未分型3例。对22例髋臼顶压缩性骨折患者的CT数据通过Mimics19.0软件进行压缩骨折块定位,并测量压缩面积大小。所有患者均采用切开复位内固定治疗。记录患者末次随访时的骨折复位质量和疗效。结果髋臼顶压缩性骨折的位置:后上象限10例,前上象限9例,同时涉及以上2个区域3例。压缩骨折面积平均为467.2 mm^2(80~1100 mm^2),压缩百分比平均为17.18%(3.1%~36.9%)。末次随访时根据Matta评分标准评定骨折复位质量:解剖复位10例,满意复位7例,复位差5例,满意率为77.3%(17/22)。末次随访时根据改良Merle d'Aubigne&Postel评分系统评定疗效:优5例,良10例,可5例,差2例,优良率为68.2%(15/22);健康调查简表评分平均为76.8分(41~99分)。并发症发生情况:股骨头缺血性坏死2例,异位骨化1例,坐骨神经损伤1例,创伤性关节炎1例。结论髋臼顶压缩性骨折可位于髋臼顶后上、前上象限或两者均涉及。了解髋臼顶压缩性骨折的位置及形态特点有助于骨折复位及固定,可促进患者术后功能恢复。
Objective To characterize the morphology of acetabular dome impaction fractures(ADIF)and evaluate its clinical significance.Methods A retrospective study was conducted of the 22 ADIF patients who had been treated at Wards of Peri-pelvic Injury,Trauma and Orthopaedics Hospital,Xi'an Honghui Hospital from January 2014 to January 2018.They were 14 males and 8 females with a mean age of 58.9 years(from 30 to 85 years).By the Letournel-Judet classification,there were one anterior column fracture,one posterior column+posterior wall fracture,one transverse fracture,13 anterior+posterior hemitransverse fractures,2 associated both column fractures,one T-shaped fracture,and 3 unclassified fractures.The location and size of impaction was measured through software Mimics19.0 based on the CT data of the 22 patients.All the patients underwent open reduction and internal fixation.Recorded were the quality of reduction and therapeutic outcomes at the final follow-up.Results Ten ADIFs were located at the posterosuperior quadrant,9 ones at the anterosuperior quadrant and 3 ones at both of the above quadrants.The impaction size averaged 467.2 mm^2(from 80 to 1,100 mm^2)while the impaction percentage 17.18%(from 3.1%to 36.9%).By the Matta's radiographic grading at the final follow-up,anatomic reduction was achieved in 10 cases,good reduction in 7 and malreduction in 5,yielding an excellent and good rate of 77.3%(17/22).By the modified Merle d'Aubigné&Postel scoring system,the therapeutic efficacy at the final follow-up was rated as excellent in 5 cases,good in 10,fair in 5 and poor in 2,yielding an excellent and good rate of 68.2%(15/22).The mean score of SF-36 was 76.8(from 41 to 99).Avascular necrosis developed in 2 patients,heterotopic ossification in one,sciatic nerve injury in one and arthritis in one.Conclusions ADIF can be located at the posterosuperior quadrant,anterosuperior quadrant or both of the quadrants of the acetabular dome.Understanding the morphology of ADIF helps surgeons in reduction and fixation of the fracture,leading to fine functional recovery of the patients.
作者
王鹏飞
张堃
费晨
李智
张斌飞
庄岩
Wang Pengfei;Zhang Kun;Fei Chen;Li Zhi;Zhang Binfei;Zhuang Yan(Wards of Peri-pelvic Injury,Trauma and Orthopaedics Hospital,Xi'an Honghui Hospital,Xi'an 710054,China;Xi'an Medical College,Xi'an 710054,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2020年第12期1029-1033,共5页
Chinese Journal of Orthopaedic Trauma
关键词
髋臼
骨折
骨折
压缩性
臼顶
形态学
Acetabulum
Fractures,bone
Fractures,compression
Acetabular dome
Morphology
