采用 AO 股骨大牵开器有效髋关节牵开治疗合并边缘嵌压和关节内嵌顿骨块的髋臼骨折。

Efficient hip joint distraction using the AO large femoral distractor in treating acetabular fractures associated with marginal impaction and intraarticular incarcerated fragments.

机构信息

Orthopaedic Department, Assiut University Hospital, Assiut, Egypt.

Orthopaedic Department, Qena faculty of medicine and University Hospital, South Valley University, Qena, Egypt.

出版信息

BMC Musculoskelet Disord. 2024 Mar 27;25(1):242. doi: 10.1186/s12891-023-07143-w.

DOI:10.1186/s12891-023-07143-w

PMID:38539141

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10967084/

Abstract

PURPOSE

The results after acetabular fracture are primarily related to the quality of articular reduction. Using the AO large femoral distractor, incarcerated fragments can be easily removed, and marginally impacted fragments can be elevated under direct visualization without further re-dislocating the joint. The current study aimed to evaluate our early results of using the AO large femoral distractor as an assisting tool during ORIF of acetabular fractures associated with marginal impaction or intraarticular incarcerated fragments.

METHODS

Eighteen patients were included in this retrospective case series study diagnosed with an acetabular fracture associated with either marginal impaction injury or an intraarticular incarcerated fragment. On a usual operative table, all patients were operated upon in a prone position through the Kocher Langenbeck approach. The AO large femoral distractor was used to facilitate hip joint distraction. Postoperative fracture reduction and joint clearance were assessed in the immediate postoperative CT scans.

RESULTS

The average age of the patients was 30 ± 8.2 years; 13 (72.2%) were males. All cases had a posterior wall fracture, and it was associated with transverse fractures, posterior column fractures, and T-type fractures in five (27.8%), two (11.1%), and one (5.6%) patients, respectively. Intraarticular incarcerated fragments were present in 13 (72.2%) cases and marginal impaction in five (27.8%). Fracture reduction measured on the postoperative CT scans showed an anatomical reduction in 14 (77.8%) patients, imperfect in four (22.2%), and complete clearance of the hip joint of any incarcerated fragments.

CONCLUSION

The use of the AO large femoral distractor is a reliable and reproducible technique that can be applied to assist in the removal of incarcerated intraarticular fragments and to ease the reduction of marginally impacted injuries associated with acetabular fractures.

摘要

目的

髋臼骨折的结果主要与关节面复位质量有关。使用 AO 大股骨牵开器可以轻松去除嵌顿的骨折块，并在直视下抬高边缘嵌插的骨折块，而不会进一步使关节再脱位。本研究旨在评估我们使用 AO 大股骨牵开器作为辅助工具治疗髋臼骨折伴边缘嵌插或关节内嵌顿骨折块的早期结果。

方法

本回顾性病例系列研究纳入了 18 例诊断为髋臼骨折伴边缘嵌插伤或关节内嵌顿骨折块的患者。所有患者均在常规手术台上采用改良 Kocher-Langenbeck 入路，俯位手术。使用 AO 大股骨牵开器来辅助髋关节牵开。术后即刻行 CT 扫描评估骨折复位和关节间隙情况。

结果

患者的平均年龄为 30±8.2 岁；男性 13 例（72.2%）。所有病例均为后壁骨折，其中 5 例（27.8%）合并横行骨折，2 例（11.1%）合并后柱骨折，1 例（5.6%）合并 T 型骨折。13 例（72.2%）存在关节内嵌顿骨折块，5 例（27.8%）存在边缘嵌插。术后 CT 扫描显示 14 例（77.8%）解剖复位，4 例（22.2%）复位不理想，所有关节内嵌顿骨折块均完全清除。