髋臼后壁骨折应用T形钢板联合重建钢板弹性固定与平行双解剖锁定钢板内固定治疗的疗效对比研究

doi:10.3969/j.issn.1005-6483.2021.02.019

摘要/Abstract

摘要： 目的：比较T形钢板联合重建钢板弹性固定与平行双解剖锁定钢板内固定治疗髋臼后壁骨折的疗效。方法：2013年1月～2019年1月收治的髋臼后壁骨折并接受手术治疗病人31例，按照手术方式分为两组，联合钢板组17例，行T形钢板联合重建钢板弹性固定；平行钢板组14例，行平行双解剖锁定钢板内固定。采用改良疼痛视觉模拟评分(VAS) 、Map评分和Harris评分评价临床结果,应用影像学改良Matta评定分级标准评估骨折复位质量。结果：31例病人顺利完成手术。联合钢板组病人的手术时间[(123.06±18.38)分钟]短于平行钢板组[(139.29±22.61)]分钟。联合钢板组病人术中出血量[(184.12±55.12)ml]少于平行钢板组[(230.71±43.58)ml]，差异有统计学意义(P＜0.05)。两组病人疼痛均逐步减轻、功能改善。平行钢板组完全负重时间[(13.71±1.31)周]优于联合钢板组[(15.50±2.10)周]，差异有统计学意义(P＜0.05)。随术后时间推移两组病人(联合钢板对比平行钢板)VAS评分均显著降低(3.06±0.75，2.29±0.69，1.24±0.44比3.71±1.07，2.50±0.65，1.36±0.50)，而Harris评分(59.71±4.75，81.94±8.74，91.82±3.17比57.14±8.47，79.71±7.21，90.57±5.30)和改良Map评分(8.29±1.31，14.53±1.59，17.53±1.23比7.79±0.80,13.71±1.64,16.57±1.55)显著增加，相同时间点，联合钢板组的VAS、Map评分优于平行钢板组，但差异均无统计学意义(P>0.05)。T形钢板联合重建钢板弹性固定组优良率为94.12%，平行钢板组复位质量优良率为85.71%。结论：T形钢板联合重建钢板弹性固定与平行双解剖锁定钢板固定髋臼后壁骨折在稳定性、髋关节功能恢复等方面均获得良好疗效。但采用联合钢板方式手术用时较短，术后康复更佳。

关键词: 髋臼后壁骨折, 解剖锁定钢板, 弹性固定

Abstract: Objective：To explore and compare the curative effect of Tshaped plate combined with reconstruction of plate elastic fixation and parallel double anatomical locking plate internal fixation on posterior acetabular wall fractures.Methods：A retrospective analysis of the clinical data of patients with acetabular posterior wall fractures and surgical treatments admitted from January 2013 to January 2019.A total of 31 patients were included.Among them,17 cases underwent elastic fixation with Tshaped steel plate combined with reconstruction,and 14 cases underwent internal fixation with parallel double anatomical locking plates.Modified pain visual analogue scale(VAS),Map score and Harris score were used to evaluate the clinical results,and the quality of fracture reduction was evaluated by the imaging modified Matta grading standard.Results：31 patients successfully completed the operation.The operation time[(123.06±18.38)min] and intraoperative blood loss[(184.12±55.12)ml] of patients with combined steel plates were significantly less than those of patients with parallel steel plates[(139.29±22.61)min,(230.71±43.58)ml],and the differences were statistically significant(P<0.05).The pain in both groups was gradually reduced and the function improved.The parallel steel plate group's complete weight bearing time in parallel steel plates group[(13.71±1.31)w] was better than that of the combined steel plate group[(15.50±2.10)w],and the difference was statistically significant(P<0.05).With the passage of time after surgery,the VAS scores of the two groups were significantly reduced[(3.06±0.75，2.29±0.69，1.24±0.44)vs(3.71±1.07，2.50±0.65，1.36±0.50)],while the Harris score[(59.71±4.75，81.94±8.74，91.82±3.17)vs(57.14±8.47，79.71±7.21，90.57±5.30)] and the Map scores[(8.29±1.31，14.53±1.59，17.53±1.23)vs(7.79±0.80,13.71±1.64,16.57±1.55)] were significantly increased.At the same time point,the VAS and Map scores of the combined steel plate group were better than those of the parallel steel plate group,and there was no statistical difference(P> 0.05).Conclusion：Tshaped plate elastic fixation combined with reconstruction plate and parallel double acetabular anatomical locking plate fixation of posterior acetabular wall fractures have achieved good results in terms of stability and hip function recovery.However,the operation time using the combined steel plate method is shorter and the postoperative recovery is better.

Key words: fracture of the posterior wall of the acetabulum, anatomical locking plate, elastic fixation

阿卜杜迪力拜尔·阿卜杜拉, 张臣鸣, 曹发奇. 髋臼后壁骨折应用T形钢板联合重建钢板弹性固定与平行双解剖锁定钢板内固定治疗的疗效对比研究[J]. 临床外科杂志, 2021, 29(2): 161-164.

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