Objective: To explore the effectiveness of the calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach.
Methods: Between January 2015 and December 2017, 18 patients with acetabular fracture involving quadrilateral surface were treated with the calcaneal plate bridge reconstruction plate via the modified Stoppa approach. There were 12 males and 6 females. The age ranged from 28 to 63 years (mean, 39 years). The cause of injury was traffic accident in 13 cases and falling from height in 5 cases. According to the Letournel-Judet classification, there were 10 cases of anterior and posterior column fractures, 6 cases of T-shaped fractures, and 2 cases of anterior column and posterior semi-transevere fractures. The interval from injury to operation was 6 to 24 days (mean, 8.6 days). The reduction quality was assessed by postoperative X-ray film and CT according to the criteria proposed by Matta. The hip joint function was assessed by the modified Merled'Aubigné-Postel score.
Results: The operation time was 120-240 minutes (mean, 165 minutes) and the intraoperative blood loss was 600-1 400 mL (mean, 850 mL). All patients were followed up 18-30 months (mean, 24.5 months). There were 2 cases of the fat liquefaction of abdominal incisions, 3 cases of intraoperative injury of lateral femoral cutaneous nerve, 1 case of lower limb thrombosis, and 1 case of abdominal pain and hematuria due to intraoperative accidental bladder injury. According to the criteria proposed by Matta, the reduction quality rated as anatomic reduction in 12 cases, satisfactory reduction in 5 cases, and unsatisfied reduction in 1 case, and the satisfaction rate was 94.4%. All fractures healed with the healing time of 3-5 months (mean, 3.4 months). During follow-up, no internal fixator loosening, breakage, or fracture displacement occurred. At last follow-up, according to modified Merled'Aubigné-Postel score, hip joint functions rated as excellent in 11 cases, good in 4 cases, fair in 2 cases, and poor in 1 case. The excellent and good rate was 83.3%.
Conclusion: Application of calcaneal plate bridge reconstruction plate via the modified Stoppa approach for the acetabular fracture involving the quadrilateral surface can obtain satisfactory effectiveness.
目的: 探讨经改良 Stoppa 入路跟骨钢板桥接重建钢板固定治疗累及方形区的髋臼骨折的临床疗效。.
方法: 2015 年 1 月—2017 年 12 月，采用经改良 Stoppa 入路跟骨钢板桥接重建钢板固定治疗 18 例累及方形区的髋臼骨折患者。男 12 例，女 6 例；年龄 28～63 岁，平均 39 岁。致伤原因：交通事故伤 13 例，高处坠落伤 5 例。根据 Letournel-Judet 分型：双柱骨折 10 例，T 型骨折 6 例，前柱伴后半横形骨折 2 例。受伤至手术时间 6～24 d，平均 8.6 d。术后复查 X 线片及 CT，根据 Matta 影像学标准评价骨折复位质量；根据改良的 Merled’ Aubigné-Postel评分标准评价髋关节功能。.
结果: 手术时间 120～240 min，平均 165 min；术中出血量 600～1 400 mL，平均 850 mL。患者均获随访，随访时间 18～30 个月，平均 24.5 个月。术后 2 例腹壁切口脂肪液化，3 例出现股外侧皮神经支配区域麻木，1 例下肢深静脉血栓形成，1 例因术中误损伤膀胱出现腹痛、血尿。术后根据 Matta 影像学标准评价骨折复位质量，其中解剖复位 12 例、满意复位 5 例、不满意复位 1 例，复位满意率为 94.4%。骨折均获骨性愈合，愈合时间 3～5 个月，平均 3.4 个月。随访期间无 1 例发生内固定物松动、断裂或骨折再次移位。末次随访时，根据改良的 Merled’ Aubigné-Postel 评分标准，髋关节功能获优 11 例、良 4 例、可 2 例、差 1 例，优良率为 83.3%。.
结论: 经改良 Stoppa 入路跟骨钢板桥接重建钢板固定治疗累及方形区的髋臼骨折可获得满意疗效。.
Keywords: Acetabular fracture; calcaneal plate; internal fixation; modified Stoppa approach; quadrilateral surface; reconstruction plate.