Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany.
ZESBO-Center for Research on Musculoskeletal System, Leipzig University, Leipzig, Germany.
PLoS One. 2022 Jul 27;17(7):e0270866. doi: 10.1371/journal.pone.0270866. eCollection 2022.
Acetabular fractures pose high demands on the surgeon and in the case of osteosynthetic treatment, anatomical reconstruction has the highest priority to achieve a good outcome. However, especially in older patients with poor bone quality, even anatomical reconstruction is no guarantee for a good clinical outcome and may nevertheless end in early osteoarthritis. Primary arthroplasty therefore has an increasing importance in the treatment of these patients. The aim of this study was to biomechanically compare fracture gap displacement and failure load as an assessment measure of the primary stability of conventional plate osteosynthesis with the treatment using a sole multi-hole cup for acetabular fractures.
Six hemi-pelvises each with anterior column and posterior hemi-transverse (ACPHT) fracture were treated with either plate osteosynthesis or a multi-hole cup. The tests were carried out in a standardised test set-up with cyclic loading in various stages between 150 N and 2500 N. The fracture gap displacement was recorded with optical 3D measuring and the failure load was determined after the cyclic measurement.
With increasing force, the fracture gap displacement increased in both procedures. In each group there was one treatment which failed at the cyclic loading test and a bone fragment was broken out. The primary stability in arthroplasty was comparable to that of the standard osteosynthesis.
The results found seem promising that the primary arthroplasty with a sole multi-hole cup and corresponding screw fixation achieves an initial stability comparable to osteosynthesis for typical ACPHT fractures. However, further clinical studies are needed to prove that the cups heal solidly into the bone.
髋臼骨折对外科医生要求很高，在骨合成治疗的情况下，解剖重建是获得良好结果的首要任务。然而，特别是在骨质量较差的老年患者中，即使进行解剖重建也不能保证良好的临床结果，并且仍然可能导致早期骨关节炎。因此，在这些患者的治疗中，初次关节置换术的重要性日益增加。本研究旨在从生物力学角度比较常规钢板骨合成治疗与单孔多杯治疗髋臼骨折的初始稳定性，评估骨折间隙位移和失效负荷。
用钢板骨合成或多孔杯治疗 6 个半骨盆的前柱和后半横突骨折（ACPHT）。测试在标准化测试装置中进行，在 150N 至 2500N 的不同阶段进行循环加载。使用光学 3D 测量记录骨折间隙位移，在循环测量后确定失效负荷。
随着力的增加，两种方法的骨折间隙位移都增加了。在每组中，有一个治疗在循环加载测试中失效，一块骨碎片断裂。初次稳定性在关节置换术中与标准骨合成相当。
多孔杯和相应螺钉固定的初次关节置换术具有与典型 ACPHT 骨折的骨合成相当的初始稳定性，这一结果似乎很有希望。然而，需要进一步的临床研究来证明杯体是否能牢固地愈合到骨中。
