Nicol Graeme, Sanders Ethan, Liew Allan, Wilkin Geoffrey, Gofton Wade T, Papp Steven, Grammatopoulos George
Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1045-1052. doi: 10.1016/j.jcot.2020.10.001. Epub 2020 Oct 7.
Acetabular fractures in the elderly frequently involve segmental quadrilateral plate injury, yet no consensus exists on how to best control the femoral head medial displacement. Quadrilateral surface plates (QSP) were developed to help buttress these challenging fractures. The study aims to 1) Determine the prevalence of segmental quadrilateral plate fractures (SQPF) in elderly patients; and 2) Assess if utilization of a QSP is associated with improved acetabulum fracture reduction and outcome.
This was a retrospective study conducted at a level-1 trauma centre. . All patients over 60-years that sustained an acetabular fracture between 2007 and 2019 were reviewed. Pre-operative pelvic radiographs and CT imaging were reviewed for 96 patients, to assess for SQPF. From the 96 patients reviewed, over one third of patients (n = 40, 41.6%) sustained a SQPF. Patients that had an acute-THA (n = 7) were excluded as were patients that underwent an ORIF but did not have a QSP or an anterior column buttress plate (n = 3). The remaining 30 formed the study's cohort. We assessed the ability to achieve and maintain reduction in this elderly population, and compared outcomes using traditional anterior column buttress plates (ilioingual or intra-pelvic approach) versus an intra-pelvic pre-contoured buttress suprapectineal plate (QSP). Outcome measures included: fracture reduction using the Matta classification (desirable: anatomical/imperfect and poor), re-operations, conversion to THA and Oxford Hip Score (OHS) (for the preserved hips).
Ten patients had an ORIF with utilization of a QSP (QSP-group), and 20 had an ORIF but did not have the QSP (non-QSP-group). There was no difference in patient demographics between groups. Fracture patterns were also similar (p = 0.6). Postoperative fracture reduction was desirable (anatomical/imperfect) in 17 patients and poor in 13. Improved ability to achieve a desirable reduction was seen in the QSP-group (p = 0.02). Conversion to THA was significantly lower in patients that had a desirable fracture reduction (appropriate: 3/17; poor: 7/13). No patients in the QSP-group have required a THA to-date, compared to 10/20 patients in the non-QSP-group (p = 0.01). The mean time to THA was 1.6 ± 2.1 year. There was no difference in OHS between the two groups (34.4 ± 10.3).
Elderly acetabulum fractures have a high incidence (approaching 40%) of segmental QPF. Desirable (anatomical/imperfect) fracture reduction was associated with improved outcome. The use of a QSP was associated with improved ability to achieve an appropriate reduction. A QSP should be considered as they are both reliable and reproducible with a significantly improved fracture reduction and lower conversion to THA.
老年髋臼骨折常累及节段性四边形板损伤，但对于如何最佳控制股骨头内侧移位尚无共识。四边形表面钢板（QSP）被开发用于辅助支撑这些具有挑战性的骨折。本研究旨在：1）确定老年患者节段性四边形板骨折（SQPF）的患病率；2）评估使用QSP是否与髋臼骨折复位改善及预后相关。
这是一项在一级创伤中心进行的回顾性研究。对2007年至2019年间所有60岁以上发生髋臼骨折的患者进行了回顾。对96例患者的术前骨盆X线片和CT影像进行了评估，以确定是否存在SQPF。在这96例接受评估的患者中，超过三分之一的患者（n = 40，41.6%）发生了SQPF。急性全髋关节置换术（n = 7）患者以及接受切开复位内固定术（ORIF）但未使用QSP或前路柱支撑钢板的患者（n = 3）被排除在外。其余30例患者组成了研究队列。我们评估了该老年人群实现并维持骨折复位的能力，并比较了使用传统前路柱支撑钢板（髂腹股沟或盆腔内入路）与盆腔内预塑形支撑耻骨上钢板（QSP）的预后。预后指标包括：使用Matta分类法评估骨折复位情况（理想：解剖复位/欠佳复位和差复位）、再次手术、转为全髋关节置换术以及牛津髋关节评分（OHS）（针对保留的髋关节）。
10例患者接受了使用QSP的ORIF（QSP组），20例患者接受了ORIF但未使用QSP（非QSP组）。两组患者的人口统计学特征无差异。骨折类型也相似（p = 0.6）。术后17例患者骨折复位理想（解剖复位/欠佳复位），13例患者复位差。QSP组实现理想复位的能力有所提高（p = 0.02）。骨折复位理想的患者转为全髋关节置换术的比例显著更低（合适：3/17；差：7/13）。截至目前，QSP组尚无患者需要进行全髋关节置换术，而非QSP组为10/20例患者（p = 0.01）。转为全髋关节置换术的平均时间为1.6 ± 2.1年。两组之间的OHS无差异（34.4 ± 10.3）。
老年髋臼骨折节段性QPF的发生率较高（接近40%）。理想（解剖复位/欠佳复位）的骨折复位与改善的预后相关。使用QSP与实现合适复位的能力提高相关。应考虑使用QSP，因为它们既可靠又可重复，能显著改善骨折复位并降低转为全髋关节置换术的比例。
