Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
Department of Trauma, Orthopaedic Surgery and Sports Traumatology, BG Trauma Hospital Hamburg, Hamburg, Germany.
Arch Orthop Trauma Surg. 2022 Jul;142(7):1539-1546. doi: 10.1007/s00402-021-03867-3. Epub 2021 Mar 24.
To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures.
A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography.
Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty.
A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.
研究解剖预成型三维耻骨上钢板的适应证范围，并评估不同类型髋臼骨折的骨密度对影像学结果的影响。
回顾性分析了 50 例采用耻骨上解剖钢板治疗的髋臼骨折患者（患者年龄 69±23 岁）的连续病例系列。分析包括：损伤机制、骨折类型、手术入路、是否需要额外的全髋关节置换术、术中或术后并发症以及术后计算机断层扫描的骨密度和影像学结果。
最常见的是前柱骨折伴或不伴半横形骨折以及合并的双柱骨折。98%（49/50）的病例采用了前盆腔入路（AIP）作为主要入路，13/50 例（26%）额外使用了髂腹股沟入路的第一窗口。骨密度测定显示 70%（31/44）存在骨质量受损。在这个亚组中，术后台阶和间隙明显更大（p<0.05）。如果骨质量正常，术后台阶骨折复位质量为解剖结果的 92%，如果骨质量受损，则为 46%（p<0.05）。在 7 例（14%）中，钢板与急性初次关节置换联合使用。
预成型耻骨上钢板在以老年人为主的多种适应证中提供了良好的影像学结果。骨质量受损会显著增加复位效果不佳的风险。在关节广泛破坏的情况下，与全髋关节置换术相结合是一种有价值的选择。
