Fraser Tristan R, Khalefa Mohamed A, Chesser Tim, Ward Anthony J, Acharya Mehool
Orthopaedic Surgery, North Bristol NHS Trust, Bristol, GBR.
Orthopaedics, Cairo University, Cairo, EGY.
Cureus. 2024 Nov 5;16(11):e73079. doi: 10.7759/cureus.73079. eCollection 2024 Nov.
Background Acetabular fractures with quadrilateral plate involvement have been shown to have a high rate of complications. Anatomic suprapectineal plating systems have been developed to manage these injuries with good short-term outcomes. However, long-term maintenance of anatomical reduction and functional outcomes has yet to be established. The aim of this study is to maintain reduction and functional outcomes at a minimum of five years of follow-up. Materials and methods This is a retrospective cohort study from a prospective database examining patients aged over 16 years following fixation of acetabular fractures with quadrilateral plate involvement at a trauma center in the United Kingdom. All patients had acetabular fracture fixation with an anatomically designed suprapectineal plate. Patients were admitted from March 2014 to January 2017. Primary outcomes included objective radiological outcomes such as reduction quality, maintenance of reduction, and subjective patient-related outcome measures (PROMs) using the Oxford Hip Score (OHS) and EuroQol EQ5D Score at a minimum of five years post-operatively. Secondary outcomes recorded included metalwork failure and complications such as reoperation, neurological deficit, and mortality. Results 16 patients met our eligibility criteria in this cohort. Post-operative mean OHS at a minimum of five years was 40.5 (SD=11.9), with a median score of 45. Post-operative mean EuroQol EQ-5D scores at a minimum of 5 years were 0.83 (SD=0.25). Radiographic outcomes were assessed with AP and Judet plain radiographs at a minimum of five years follow-up. Preoperatively, 56.3% (9) showed evidence of dome comminution, with 18.8% (3) demonstrating dome impaction. 93.7% (15) had quadrilateral plate involvement. 12.5% (2) showed evidence of femoral head injury. The rate of conversion to total hip replacement was 6.25% (1) at 15 months post-injury. Conclusions Maintenance of reduction and functional and patient-reported outcomes of patients who underwent open reduction and internal fixation of an acetabular fracture using anatomically contoured suprapectineal plates have satisfactory radiological and functional outcomes at five-year follow-up.
已证实累及四边形板的髋臼骨折并发症发生率很高。已开发出解剖型耻骨上钢板系统来处理这些损伤，短期效果良好。然而，解剖复位的长期维持及功能结果尚未明确。本研究的目的是在至少五年的随访中维持复位及功能结果。
这是一项回顾性队列研究，来自一个前瞻性数据库，研究对象为英国一家创伤中心16岁以上髋臼骨折伴四边形板累及患者接受固定术后的情况。所有患者均采用解剖设计的耻骨上钢板进行髋臼骨折固定。患者于2014年3月至2017年1月入院。主要结局包括客观放射学结局，如复位质量、复位维持情况，以及使用牛津髋关节评分（OHS）和欧洲五维健康量表（EuroQol EQ-5D）评分的主观患者相关结局指标（PROMs），均在术后至少五年时评估。记录的次要结局包括内固定失败以及再次手术、神经功能缺损和死亡等并发症。
该队列中有16例患者符合我们的纳入标准。术后至少五年时的平均OHS为40.5（标准差=11.9），中位数为45。术后至少五年时的平均欧洲五维健康量表EQ-5D评分为0.83（标准差=0.25）。在至少五年的随访中，通过前后位（AP）和Judet位X线平片评估放射学结局。术前，56.3%（9例）显示有髋臼顶粉碎的证据，18.8%（3例）有髋臼顶撞击。93.7%（15例）累及四边形板。12.5%（2例）有股骨头损伤的证据。伤后15个月时全髋关节置换的转换率为6.25%（1例）。
使用解剖塑形的耻骨上钢板对髋臼骨折进行切开复位内固定的患者，在五年随访时，复位维持情况以及功能和患者报告的结局具有令人满意的放射学和功能结果。
