Zhong Ziyi, Feng Zihang, Tong Kai, Lin Shiyuan, Yang Yunping, Wang Gang
Department of Trauma Orthopedics, Nanfang Hospital, Southern Medical University, Guang Zhou, China.
Affiliated Dongguan People's Hospital, Southern Medical University, Dongguan, China.
Orthop Surg. 2024 Aug;16(8):1955-1962. doi: 10.1111/os.14140. Epub 2024 Jun 19.
Most both-column acetabular fractures are combined with posterior wall fragments. However, the morphology of this posterior wall is varied, and how to fix this posterior wall remains a controversial topic. To investigate the morphological characteristics of posterior wall fragments of both-column acetabular fractures and select corresponding fixation methods.
Data from 352 patients with acetabular fractures admitted to the level one trauma centre in our hospital between January 2006 and December 2022 were collected. The morphology of posterior wall fragments was observed and analyzed in 83 cases of both-column acetabular fractures and classified according to the consistency of posterior wall morphology. A fracture map of the posterior wall was created on a normal template according to the three morphological types of posterior wall fragments. Finally, the high-incidence area of the posterior wall fracture was projected onto the iliac fossa and the medial side of the posterior column to guide the fixation of the posterior wall fragment using the anterior intrapelvic approach.
Fractures were divided into four types: I, large posterior wall fragment which was high in the ilium bone (34 cases, 41.0%); II, posterior wall fragment in the acetabular parietal region (18 cases, 21.7%); III, posterior wall marginal fracture (10 cases, 12.0%); and IV, non-combined posterior wall fracture (21 cases, 25.3%). The most common morphologies of the posterior wall fragments of the first two types were mapped and projected onto the anterior iliac inner plate and medial side of the posterior column, where the corresponding area could be used to guide the insertion of the internal fixation.
Both-column acetabular fractures combined with posterior wall fractures can be divided into four types according to the morphology of the posterior wall fragment. Understanding the corresponding three-dimensional morphology and projection position of different types of these fragments can help surgeons determine the position and orientation of internal fixation of posterior wall fractures.
多数双柱髋臼骨折合并后壁骨折块。然而，该后壁的形态各异，如何固定此后壁仍是一个有争议的话题。旨在研究双柱髋臼骨折后壁骨折块的形态特征并选择相应的固定方法。
收集2006年1月至2022年12月我院一级创伤中心收治的352例髋臼骨折患者的数据。观察并分析83例双柱髋臼骨折后壁骨折块的形态，根据后壁形态的一致性进行分类。根据后壁骨折块的三种形态类型，在正常模板上绘制后壁骨折图谱。最后，将后壁骨折的高发区域投影到髂窝和后柱内侧，以指导采用经骨盆内前路固定后壁骨折块。
骨折分为四种类型：Ⅰ型，髂骨高位大后壁骨折块（34例，41.0%）；Ⅱ型，髋臼顶区后壁骨折块（18例，21.7%）；Ⅲ型，后壁边缘骨折（10例，12.0%）；Ⅳ型，非合并后壁骨折（21例，25.3%）。绘制并将前两种类型后壁骨折块最常见的形态投影到髂前内板和后柱内侧，相应区域可用于指导内固定的置入。
双柱髋臼骨折合并后壁骨折可根据后壁骨折块的形态分为四种类型。了解这些不同类型骨折块的相应三维形态和投影位置有助于外科医生确定后壁骨折内固定的位置和方向。
