Pascarella R, Commessatti M, Politano R, Maresca A, Del Torto M, Chehrassan M, Fantasia R
Orthopedic and Traumatology Department, Riuniti Hospital, Ancona, Italy,
J Orthop Traumatol. 2014 Sep;15(3):181-7. doi: 10.1007/s10195-014-0291-1. Epub 2014 Mar 27.
Posterior wall fracture is the most common acetabular fracture. Comminuted fractures with an impacted segment represent a subtype of this injury. The subchondral bone of the articular zone is compressed and causes a bone defect. The impacted fragment should be isolated, mobilized, and then reduced. A bone graft should be used to fill the gap. The other fragments are fixed following the reduction of the impacted segment.
Ten patients with comminuted fractures and impacted segments with bone defects were enrolled in our study, from January 2010 to July 2012. Autogenous bone grafts from the greater trochanter were used to fill the gap in all patients. The reduction was achieved through the insertion of the graft above the impacted fracture, and plate fixation was performed subsequently. Merle d'Aubigne and Postel scoring, modified by Matta, was applied to evaluate the patients during follow-up. The mean follow-up was 12 months.
The clinical results included one "excellent", four "very good", four "good" and one "poor". Pain in the zone of graft harvesting was not detected in any patient. Femoral head necrosis was observed in one case. No other severe complications were detected.
Using an autogenous bone graft to fill the bone defect supplies excellent mechanical stability without any severe complications at the donor site. This surgical technique seems to be effective and safe in treating a comminuted fracture of the posterior wall in association with an impacted segment.
Level IV.
后壁骨折是最常见的髋臼骨折。伴有嵌插骨块的粉碎性骨折是该损伤的一种亚型。关节区的软骨下骨被压缩并导致骨缺损。应分离、移动嵌插骨块，然后进行复位。应使用骨移植来填补间隙。在嵌插骨块复位后固定其他骨块。
2010年1月至2012年7月，10例伴有嵌插骨块及骨缺损的粉碎性骨折患者纳入本研究。所有患者均使用取自大转子的自体骨移植来填补间隙。通过在嵌插骨折上方植入移植骨实现复位，随后进行钢板固定。采用经Matta修改的Merle d'Aubigne和Postel评分在随访期间对患者进行评估。平均随访时间为12个月。
临床结果包括1例“优”、4例“良”、4例“可”和1例“差”。未在任何患者中检测到取骨部位疼痛。观察到1例股骨头坏死。未检测到其他严重并发症。
使用自体骨移植填补骨缺损可提供良好的机械稳定性，且供区无任何严重并发症。这种手术技术在治疗后壁粉碎性骨折合并嵌插骨块时似乎有效且安全。
四级。
