通过髂腹股沟前入路,将特殊轮廓骨盆边缘重建钛钢板与经钢板支撑螺钉(四边形螺钉)相结合,用于治疗四边形钢板受累的髋臼骨折

IF 1.6 4区 医学 Q2 SURGERY
Wei Wang, Xianhua Cai, Ximing Liu, Guodong Wang, Hui Kang, Shenglong Qian
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Therefore, the primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures.MethodsWe conducted a retrospective analysis of prospectively collected data from 48 patients (31 males and 17 females) who suffered from acute displaced fractures of the QLP and were treated between January 2012 and December 2019 using a special contoured plate combined with quadrilateral screws. The patients' mean age was 47.56 ± 11.31 years (range: 19–73 years). Fracture patterns included 20 both-column fractures, 12 anterior column and posterior hemitransverse fractures, eight T-type fractures, five transverse fractures and three anterior column fractures with the QLP affected, all of which had femoral head protrusion. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d’Aubigné and Harris Hip scores (HHS).ResultsThe patients were followed up for an average of 48.36 ± 12.94 months (ranging from 24 to 84 months). The mean operative time was 246.08 ± 54.30 min (ranging from 178 to 397 min), and the average blood loss was 715.16 ± 263.84 ml (ranging from 400 to 2000ml). The radiological grading at postoperative stage showed anatomical reduction in 30 patients (62.50%), satisfactory reduction in 14 patients (29.17%), and poor reduction in four patients (8.33%). 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引用次数: 0

摘要

背景处理涉及四边形钢板(QLP)的复杂髋臼骨折对外科医生来说是一项挑战,尤其是在合并粉碎和骨质疏松症的情况下。传统的植入物不能提供足够的固定强度或适当的匹配。新型预塑形髋臼下托板可能存在一些缺陷,如与 QLP 内侧表面的配合不准确,无法施加反向压缩力以抵抗股骨头向内侧移位。因此,本研究的主要目的是引入一种新技术,利用特殊轮廓的骨盆边缘重建钛板和四边形螺钉,通过髂腹股沟入路减少和稳定涉及 QLP 的髋臼骨折。方法我们对前瞻性收集的 48 例 QLP 急性移位骨折患者(男性 31 例,女性 17 例)的数据进行了回顾性分析,这些患者在 2012 年 1 月至 2019 年 12 月期间接受了特殊轮廓钢板结合四边形螺钉的治疗。患者的平均年龄为 47.56±11.31 岁(范围:19-73 岁)。骨折类型包括20例双柱骨折、12例前柱和后半横断骨折、8例T型骨折、5例横断骨折和3例影响QLP的前柱骨折,所有骨折均伴有股骨头突出。术后即刻的还原质量根据 Matta 标准进行评估。随访期间使用改良的 Merle d'Aubigné 和 Harris 髋关节评分(HHS)评估最终临床功能。平均手术时间为(246.08±54.30)分钟(178-397分钟不等),平均失血量为(715.16±263.84)毫升(400-2000毫升不等)。术后阶段的放射学分级显示,30 例患者(62.50%)解剖学缩小,14 例患者(29.17%)缩小效果满意,4 例患者(8.33%)缩小效果不佳。在最后的随访中,未发现股骨头再次突出。在功能结果方面,26 名患者(54.17%)的平均改良 Merle d'Aubigné-Postel 评分为优(54.17%),17 名患者(35.42%)为良(35.42%),4 名患者(8.33%)为中(8.33%),1 名患者(2.08%)为差(2.08%)。23 名患者的 HHS 为优(47.92%),20 名患者的 HHS 为良(41.67%),4 名患者的 HHS 为一般(8.33%),1 名患者的 HHS 为差(2.08%)。平均 HHS 为 87.38 ± 7.86(范围从 52 到 98)。术后并发症包括两名患者的股外侧皮神经损伤,一名患者的伤口延迟愈合,随后出现腹股沟疝。结论:我们的研究结果表明,在治疗涉及 QLP 的移位性髋臼骨折时,采用专为 QLP 损伤设计的轮廓钢板,并通过髂腹股沟入路使用四边形螺钉,可以取得良好的疗效。这种简单高效的技术为外科医生处理复杂的髋臼骨折提供了一种可行的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Special contoured pelvic brim reconstruction titanium plate combined with trans-plate buttress screws (quadrilateral screws) for acetabular fractures with quadrilateral plate involvement through the anterior ilioinguinal approach
BackgroundManaging complicated acetabular fractures involving the quadrilateral plate (QLP) can be challenging for surgeons, especially when complicated by comminution and osteoporosis. Traditional implants do not provide sufficient fixed strength or a proper match. The new-type pre-contoured infrapectineal buttress plates may have drawbacks, such as inaccurate fitting on the medial surface of QLP and an inability to apply reversed compression force to resist medial displacement of femoral head. Therefore, the primary purpose of this study is to introduce a novel technique that utilizes a special contoured pelvic brim reconstruction titanium plate combined with quadrilateral screws to reduce and stabilize acetabular fractures involving the QLP through the ilioinguinal approach. Additionally, the secondary purpose is to evaluate both clinical effectiveness and radiological outcomes of this technique for QLP fractures.MethodsWe conducted a retrospective analysis of prospectively collected data from 48 patients (31 males and 17 females) who suffered from acute displaced fractures of the QLP and were treated between January 2012 and December 2019 using a special contoured plate combined with quadrilateral screws. The patients' mean age was 47.56 ± 11.31 years (range: 19–73 years). Fracture patterns included 20 both-column fractures, 12 anterior column and posterior hemitransverse fractures, eight T-type fractures, five transverse fractures and three anterior column fractures with the QLP affected, all of which had femoral head protrusion. Immediate postoperative reduction quality was evaluated according to Matta's criteria. Final clinical functions were assessed during follow-up using the modified Merle d’Aubigné and Harris Hip scores (HHS).ResultsThe patients were followed up for an average of 48.36 ± 12.94 months (ranging from 24 to 84 months). The mean operative time was 246.08 ± 54.30 min (ranging from 178 to 397 min), and the average blood loss was 715.16 ± 263.84 ml (ranging from 400 to 2000ml). The radiological grading at postoperative stage showed anatomical reduction in 30 patients (62.50%), satisfactory reduction in 14 patients (29.17%), and poor reduction in four patients (8.33%). At the final follow-up, no re-protrusion of the femoral head was observed. In terms of functional outcome, the mean modified Merle d’Aubigné-Postel score was excellent in 26 patients (54.17%), good in 17 patients (35.42%), fair in four patients (8.33%), and poor in one patient (2.08%). The HHS was excellent in 23 patients (47.92%), good in 20 patients (41.67%), fair in four patients (8.33%), and poor in one patient (2.08%). The average HHS was 87.38 ± 7.86 (ranging from 52 to 98). Postoperative complications included lateral femoral cutaneous nerve injury in two patients, delayed wound healing and subsequent development of an inguinal hernia in one patient. Late complications were observed in two patients, with one case of heterotopic ossification and another case of post-traumatic osteoarthritis underwent hip arthroplasty within two years after surgery.ConclusionOur results indicate that employing the contoured plate specifically designed for QLP injuries, in conjunction with quadrilateral screws through the ilioinguinal approach, can lead to positive outcomes in the treatment of displaced acetabular fractures involving the QLP. This straightforward and efficient technique offers a viable option for surgeons who are managing complex acetabular fractures.
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来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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