Department of Traumatic Surgery, Center for Orthopaedic Surgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Trauma Emergency Center, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Orthop Surg. 2023 Oct;15(10):2523-2531. doi: 10.1111/os.13817. Epub 2023 Aug 24.
As conventional plates require repeated pre-bending during surgery with poor matching, this study aimed to explore the design and application of an acetabular integrative anatomical plate (AIAP) via the lateral-rectus approach (LRA) in fresh complex acetabular fractures for the good reduction and fixation.
We designed an AIAP based on the anatomical morphology of the Chinese people. From March 2016 to September 2021, 178 patients with fresh complex acetabular fractures treated with an AIAP via the LRA were retrospectively analyzed. All patients were treated by the LRA under general anesthesia in a supine position. The fragments were well reduced and fixed by AIAPs. The operation time and intraoperative blood loss were recorded. All patients underwent reexamination of pelvic X-rays and CT scans and were followed up for over 1 year postoperatively. The reduction quality of fracture was evaluated according to the Matta criteria. The postoperative functional recovery was evaluated by modified Merle d'Aubigne-Postel scoring system. Statistics were analyzed by SPSS 25.0 (SPSS Inc., Chicago, IL, USA).
All 178 patients went through the operation successfully. The time from injury to operation ranged from 5 to 21 days (8.7 ± 2.6 days). The operation time ranged from 35 to 150 min (75 ± 29 min). The intraoperative blood loss was from 250 to 1400 ml (440 ± 153 ml). According to the Matta score, the fracture reduction was evaluated as excellent in 131 cases, good in 31 cases, and poor in 16 cases, with an overall excellent and good rate of 91%. Four patients suffered wound fat liquefaction and healed after fresh dressing. All patients were followed up for 1 to 5 years without wound infection. All fractures were healed. At the last follow-up, the modified Merle d'Aubigne-Postel score results were evaluated as excellent in 125 cases, good in 26 cases, and fair in 27 cases, with an overall excellent and good rate of 84.8%. Postoperative complications included six cases of traumatic arthritis of the hips and two cases of femoral head necrosis.
The LRA with an AIAP can help expose, reduce, and fix anterior and posterior columns as well as the quadrilateral area of the acetabulum, which is capable of improving the reduction quality of complex acetabular fractures and shortening surgical time and blood loss, thus reaching a good clinical efficacy.
传统钢板在术中需要反复预弯，匹配性差，本研究旨在探讨通过外侧直肌入路（LRA）应用髋臼整合解剖钢板（AIAP）治疗新鲜复杂髋臼骨折的设计和应用，以实现良好的复位和固定。
我们根据中国人的解剖形态设计了 AIAP。自 2016 年 3 月至 2021 年 9 月，回顾性分析了 178 例采用 LRA 联合 AIAP 治疗新鲜复杂髋臼骨折的患者。所有患者均在全身麻醉下仰卧位行 LRA。采用 AIAP 对骨折块进行良好复位和固定。记录手术时间和术中失血量。所有患者均行骨盆 X 线和 CT 复查，并在术后超过 1 年进行随访。根据 Matta 标准评估骨折复位质量。采用改良的 Merle d'Aubigne-Postel 评分系统评估术后功能恢复情况。采用 SPSS 25.0（SPSS Inc.，芝加哥，IL，USA）进行统计学分析。
所有 178 例患者均顺利完成手术。受伤至手术时间为 521d，平均 8.7±2.6d；手术时间为 35150min，平均 75±29min；术中出血量为 2501400ml，平均 440±153ml。根据 Matta 评分，骨折复位评估为优 131 例，良 31 例，差 16 例，优良率为 91%。4 例患者发生伤口脂肪液化，经新鲜敷料后愈合。所有患者均获随访 15 年，无伤口感染。所有骨折均愈合。末次随访时，改良的 Merle d'Aubigne-Postel 评分结果评估为优 125 例，良 26 例，可 27 例，优良率为 84.8%。术后并发症包括髋关节创伤性关节炎 6 例，股骨头坏死 2 例。
LRA 联合 AIAP 可帮助暴露、复位和固定髋臼的前柱、后柱和四边形区域，提高复杂髋臼骨折的复位质量，缩短手术时间和失血量，达到良好的临床疗效。
