Nadeem Umair, Qadir Irfan, Mazari Jahanzeb, Zaman Atiq Uz, Aziz Amer
Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
Hip Pelvis. 2021 Mar;33(1):33-39. doi: 10.5371/hp.2021.33.1.33. Epub 2021 Mar 2.
Reduction and stable fixation of the quadrilateral plate are challenging primarily due to its location in the true pelvis, limited bone stock, juxta-articular nature, and its comminution. The current study aimed to investigate the quality of reduction and functional outcomes after open reduction and internal fixation (ORIF) with infrapectineal buttress plating of the quadrilateral surface via an anterior intrapelvic approach.
We conducted a retrospective review of twenty-one patients with acetabular fractures involving quadrilateral plate operated at Ghurki Trust Teaching Hospital between January 2017 and December 2018. Radiological assessment of the quality of reduction was conducted using criteria described by Matta. Functional outcomes were evaluated using a modified Postel Merle d'Aubigné score.
The current study included 15 males and 6 females with a mean age of 40.67±12.17 years (range, 22-62 years). The most common fracture pattern was anterior column and posterior hemi-transverse in eight patients followed by true bicolumn and T-type fractures in seven and four patients respectively. Both transverse fractures were transtectal. The quality of reduction according to Matta criteria was anatomical in 14 patients, imperfect in five and poor in two. Functional outcomes were excellent in 47.6% cases, good in 42.9%, and fair in 9.5% cases. Both patients with fair outcomes had non-anatomical reduction, and one required total hip arthroplasty at a later time.
Quadrilateral plate reconstruction with an infrapectineal buttress plate applied though an anterior intrapelvic approach provides high rates of anatomical reduction and yields good functional outcomes.
四边形钢板的复位及稳定固定颇具挑战性，主要原因在于其位于真骨盆内、骨量有限、靠近关节以及存在粉碎情况。本研究旨在探讨经骨盆前路采用耻骨下支撑钢板对四边形面进行切开复位内固定（ORIF）后的复位质量及功能结果。
我们对2017年1月至2018年12月期间在古尔基信托教学医院接受手术的21例涉及四边形钢板的髋臼骨折患者进行了回顾性研究。采用Matta描述的标准对复位质量进行放射学评估。使用改良的Postel Merle d'Aubigné评分评估功能结果。
本研究纳入15例男性和6例女性，平均年龄为40.67±12.17岁（范围22 - 62岁）。最常见的骨折类型是8例患者的前柱和后半横行骨折，其次分别是7例和4例患者的真正双柱骨折和T型骨折。两处横行骨折均为经髋臼横断骨折。根据Matta标准，14例患者复位质量为解剖复位，5例为不完美复位，2例为差复位。47.6%的病例功能结果为优，42.9%为良，9.5%为可。功能结果为可的两名患者均为非解剖复位，其中一名患者后期需要进行全髋关节置换术。
经骨盆前路应用耻骨下支撑钢板进行四边形钢板重建可提供较高的解剖复位率，并产生良好的功能结果。
