University of Colorado School of Medicine, Aurora, CO.
Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO.
J Orthop Trauma. 2019 Sep;33(9):e325-e330. doi: 10.1097/BOT.0000000000001496.
To compare the stability of 3 fixation strategies for a transverse acetabular fracture: a reconstruction plate with anterior and posterior column screws (group A); an infrapectineal precontoured quadrilateral surface buttress (iPQSB) plate alone (group B); and an anterior column lag-screw and iPQSB plate (group C).
A transverse acetabular fracture was created in 18 synthetic hemipelvises. Six were fixed by each of the 3 methods described. Specimens underwent cyclic axial compressive loading to 1700N for 42,000 cycles while anterior and posterior column displacements were measured, followed 4800N for 50 cycles. Displacement and stiffness data were analyzed with analysis of variance and Tukey HSD. A Cox proportional hazards regression model was used to determine survival rate. P values < 0.05 were considered significant.
Group C had significantly less posterior column displacement (0.16 ± 0.06 mm) compared with group B (0.38 ± 0.37 mm, P < 0.0001) and group A (0.38 ± 0.37 mm, P < 0.0001). In addition, group A had significantly more anterior column displacement (0.28 ± 0.11 mm) than group B (0.22 ± 0.14 mm, P = 0.0310) and group C (0.18 ± 0.09 mm, P = 0.0001). Group C was 10.5% stiffer than group A (P = 0.0037). Group B had a 7.27x greater rate of failure than group C (95% confidence interval, 1.6-33.2).
Under anatomical loading, iPQSB plates with anterior column lag-screw fixation demonstrate increased stability in a synthetic bone transverse acetabular fracture model. Based on our data, we support additional evaluation of early weight-bearing after transverse acetabular fracture fixation in patients with healthy bone when an anterior column screw-iPQSB plate construct is used.
比较三种固定策略治疗横向髋臼骨折的稳定性：重建钢板联合前柱和后柱螺钉（A 组）；单独使用耻骨下预制四边形表面支撑钢板（iPQSB 板）（B 组）；以及前柱拉力螺钉和 iPQSB 板（C 组）。
在 18 个合成半骨盆中制造了一个横向髋臼骨折。每种方法固定 6 个标本。标本在 42000 个循环中进行循环轴向压缩加载至 1700N，同时测量前柱和后柱的位移，然后在 50 个循环中施加 4800N 的力。使用方差分析和 Tukey HSD 对位移和刚度数据进行分析。使用 Cox 比例风险回归模型确定存活率。P 值<0.05 被认为具有统计学意义。
C 组的后柱位移明显小于 B 组（0.16±0.06mm 比 0.38±0.37mm，P<0.0001）和 A 组（0.38±0.37mm，P<0.0001）。此外，A 组的前柱位移明显大于 B 组（0.28±0.11mm 比 0.22±0.14mm，P=0.0310）和 C 组（0.18±0.09mm，P=0.0001）。C 组比 A 组的刚度高 10.5%（P=0.0037）。B 组的失效风险是 C 组的 7.27 倍（95%置信区间，1.6-33.2）。
在解剖学负荷下，带有前柱拉力螺钉固定的 iPQSB 板在合成骨横向髋臼骨折模型中表现出更高的稳定性。根据我们的数据，我们支持在使用前柱螺钉-iPQSB 板固定结构时，对具有健康骨骼的横向髋臼骨折患者进行早期负重的进一步评估。
