Gültaç Emre, İltar Serkan, Özmeriç Ahmet, Koçak Aykut, Aydoğan Nevres Hürriyet, Alemdaroğlu Kadir Bahadır
Department of Orthopaedics, Ankara Training and Research Hospital, Ankara, Turkey.
Department of Orthopaedics, Muğla Sıtkı Kocman University, Muğla, Turkey.
J Clin Orthop Trauma. 2019 Sep-Oct;10(5):900-903. doi: 10.1016/j.jcot.2019.01.023. Epub 2019 Jan 29.
Modern treatment principles for posterior wall fractures have become widespread in the last decade in many countries by means of international or local courses. The purpose of this study was to compare the clinical and radiologic outcomes of acetabulum posterior wall fractures using unconventional methods of fixation, including plates placed in unusual directions, or, in the case of reoperation, only interfragmentary screws. In addition, we examined acetabulum posterior wall fractures treated by open reduction and internal fixation with standard undercountered plates from ischion to iliac bone in latter cases.
Twenty-one patients who had open reduction and internal fixation of an unstable unilateral fracture of the posterior wall of the acetabulum between 2009 and 2013 were included. Group 1 was composed of 10 former patients who were treated with unconventional methods that included a compression technique with a direct plate or solely screw fixation. Group 2 was composed of latter 11 patients who were treated with standard surgery that included undercountered plates oriented from the ischial tuberosity to the iliac bone proximally and reconstruction of marginal impaction if necessary. The functional outcome was evaluated with the use of the clinical grading system adopted by Merle d'Aubigné and Postel. The Kellgren-Lawrence radiologic criteria were used for the radiologic assessments. The reduction of the fracture, posterior dislocation, marginal impaction, mean fracture particle amount, trochanteric osteotomy and avascular necrosis were compared between the two groups and examined with the Mann-Whitney test.
In Groups 1 and 2, the median score of the modified Merle d'Aubigné and Postel clinical scoring system was 16 (8-18) and 18 (14-18), respectively. The clinical scores between the two groups were statistically significant (p < 0.01). When two groups were compared using the Kellgren-Lawrence radiographic criteria for the development of osteoarthritis, the median value in Groups 1 and 2 was 3 (0-4) and 1 (0-3), respectively (p < 0.01).
This study displays the evolution of the surgical treatment of acetabular fractures of the posterior wall in our clinic. The older methods failed in terms of exposure, diagnosis of fracture anatomy and fixation techniques. Patients treated after the surgeons took courses in this field showed evidence of superior clinical and radiological scores. We attribute these benefits to exposure, definition and treatment of marginal impaction and fixation principles.
在过去十年中，通过国际或本地课程，后壁骨折的现代治疗原则在许多国家已广泛传播。本研究的目的是比较髋臼后壁骨折采用非常规固定方法（包括以不寻常方向放置钢板，或在再次手术的情况下仅使用骨折块间螺钉）的临床和放射学结果。此外，我们还研究了在后一种情况下采用从坐骨到髂骨的标准低位钢板切开复位内固定治疗的髋臼后壁骨折。
纳入2009年至2013年间接受髋臼后壁不稳定单侧骨折切开复位内固定的21例患者。第1组由10例先前患者组成，他们接受了非常规方法治疗，包括使用直接钢板的加压技术或单纯螺钉固定。第2组由后11例患者组成，他们接受了标准手术治疗，包括从坐骨结节向近端髂骨方向放置低位钢板，并在必要时重建边缘嵌插。使用Merle d'Aubigné和Postel采用的临床分级系统评估功能结果。使用Kellgren-Lawrence放射学标准进行放射学评估。比较两组之间的骨折复位、后脱位、边缘嵌插、平均骨折碎骨量、转子截骨术和缺血性坏死情况，并采用Mann-Whitney检验进行分析。
在第1组和第2组中，改良的Merle d'Aubigné和Postel临床评分系统的中位数分别为16（8 - 18）和18（14 - 18）。两组之间的临床评分具有统计学意义（p < 0.01）。当使用Kellgren-Lawrence放射学标准比较两组骨关节炎的发展情况时，第1组和第2组的中位数分别为3（0 - 4）和1（0 - 3）（p < 0.01）。
本研究展示了我们诊所髋臼后壁骨折手术治疗的演变。旧方法在暴露、骨折解剖诊断和固定技术方面存在不足。外科医生参加该领域课程后治疗的患者显示出更好的临床和放射学评分证据。我们将这些益处归因于边缘嵌插的暴露、定义和治疗以及固定原则。
