Effect of two anterior acetabular approaches with low notch reconstruction plate fixation for acetabular quadrangular fractures #br#
YE Fang1 LAN Yinan2 HUANG Shuming1 YE Jifei1 XIE Panpan1 XING Hailin1 WANG Chong1
1.Department of Orthopedic Trauma, Lishui Central Hospital, Zhejiang Province, Lishui 323000, China;
2.Reconstructive Hand Surgery, Lishui Central Hospital, Zhejiang Province, Lishui 323000, China
Abstract：Objective To investigate the effect of low profile reconstruction plate placement in the treatment of acetabular tetragonal fractures through the parabrectus approach or the ilioinguinal approach. Methods A total of 94 patients with acetabular tetragonal fracture from January 2016 to April 2021 in Lishui Central Hospital of Zhejiang Province were enrolled and they were divided into two groups by random number table method. The control group (47 cases) was treated with low profile reconstruction plate internal fixation via ilioinguinal approach, and the observation group (47 cases) was treated with low-notch reconstruction plate internal fixation via parabrectus approach. The operative time, intraoperative blood loss, incision length, fracture healing time, acetabular reduction effect, hip joint function, pain degree and complications were compared between the two groups. Results The operation time and incision length of the observation group were shorter than those of the control group (P ＜ 0.05), and the amount of intraoperative blood loss was less than that of the control group (P ＜ 0.05). In the observation group, the excellent and good rate was higher than that of the control group (P ＜ 0.05). Overall analysis showed that there were statistically significant differences in Harris score, modified Merle D’Aubigne-Postel score and VAS score between groups, time point comparison and interaction between the two groups (P ＜ 0.05). Intragroup comparison: Harris score and modified Merle D’Aubigne-Postel score at 6 and 12 weeks after surgery were higher than those before surgery, and 12 weeks after surgery were higher than those at 6 weeks after surgery. VAS score 6 and 12 weeks after surgery was lower than that before surgery, and 12 weeks after surgery was lower than that 6 weeks after surgery (P < 0.05). Comparison between groups: Harris score and modified Merle D’Aubigne-Postel score of observation group were higher than those of control group at 6 and 12 weeks after surgery (P ＜ 0.05), VAS score was lower than that of control group (P ＜ 0.05). The total incidence of complications in the observation group was lower than that in the control group (P ＜ 0.05). Conclusion The low profile reconstruction plate approach through the parastrectus abdominis has the advantages of less trauma, simple operation and high safety, and is more conducive to the reduction of the tetrahedral fracture block and the recovery of hip joint function, which is better than the ilioinguinal approach.
[1] 陈庞涛，许一凡，李新宇，等.髋臼骨折临床分型研究进展[J].中国骨与关节损伤杂志，2021，36（4）：443-445.
[2] 吴海洋，邵启鹏，蔡贤华，等.涉及髋臼方形区骨折分型与手术治疗进展[J].创伤外科杂志，2020，22（12）：71-74.
[3] Hoelscher-Doht S，Kladny AM，Paul MM，et al. Low-profile double plating versus dorsal LCP in stabilization of the olecranon fractures [J]. Arch Orthop Trauma Surg，2021，141（2）：245-251.
[4] Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach： a 10-year perspective [J]. J Orthop Trauma，2006，20（1 Suppl）：S20-S29.
[5] 于洋，王振虎，赵力，等.人工关节置换术对老年股骨粗隆间骨折患者Harris评分和预后的影响[J].现代生物医学进展，2017，17（35）：6905-6908.
[6] D’aubigne RM，Postel M. Functional results of hip arthroplasty with acrylic prosthesis [J]. J Bone Joint Surg Am，1954，36-A（3）：451-475.
[7] Scott J，Huskisson EC. Graphic representation of pain [J]. Pain，1976，2（2）：175-184.
[8] 韩力，赵建文，王晓伟，等.不同入路手术对骨盆髋臼骨折患者骨折复位质量、髋关节功能及炎症因子的影响[J].现代生物医学进展，2020，20（7）：1289-1292.
[9] Sepehri A，Sciadini MF，Nascone JW，et al. Initial experience with the T-Clamp for temporary fixation of mechanically and hemodynamically unstable pelvic ring injuries [J]. Injury，2020，51（3）：699-704.
[10] 高剑锐，刘苏熠，冯德宏，等.髋臼四边体骨折安全置钉角度及范围的测量[J].实用临床医药志，2019，23（3）：22-23，32.
[11] Zhuang Y，Zhang K，Wang H，et al. A short buttress plate fixation of posterior column through single ilioinguinal approach for complex acetabular fractures [J]. Int Orthop，2017，41（1）：165-171.
[12] 阿卜杜迪力拜尔·阿卜杜拉，张臣鸣，曹发奇，等.髋臼后壁骨折应用T形钢板联合重建钢板弹性固定与平行双解剖锁定钢板内固定治疗的疗效对比研究[J].临床外科杂志，2021，29（2）：161-164.
[13] 严伟，郑树恒，汪鑫，等.低切迹多向锁定与标准钢板治疗粉碎性跟骨骨折[J].中国矫形外科杂志，2019，27（16）：1471-1476.
[14] 王建卫，胡东才，李琰，等.垂直低切迹双钢板治疗锁骨远端Neer ⅡB型骨折[J].中华创伤杂志，2020，36（5）：442-447.
[15] 钟晓，贾叙锋，黄光平，等.锁定加压重建钢板不同途径内固定置入治疗髋臼横行骨折的生物力学比较[J].中国组织工程研究，2018，22（27）：4305-4310.
[16] 敖荣广，禹宝庆，姜新华，等.低切迹解剖锁定钢板治疗成人锁骨中段骨折的临床疗效[J].中华肩肘外科电子杂志，2015，3（3）：19-23.
[17] 鹿军，孙川，梁晓军，等.低切迹后外侧接骨板内固定治疗Danis-Weber B型腓骨骨折的临床观察[J].中国骨与关节损伤杂志，2013，28（10）：975-976.
[18] 张东，薛锋，肖海军.低切迹锁定小钢板微创治疗肩关节脱位伴肱骨大结节骨折临床疗效[J].国际骨科学杂志，2017，38（2）：125-128.
[19] Tannast M，Keel M，Siebenrock KA，et al. Open reduction and internal fixation of acetabular fractiares using the modified stoppa approach [J]. JBJS Essent Surg Tech，2019，9（1）：e3.
[20] 安雪军，徐宝山，王小健，等.前后联合入路翻修治疗复杂髋臼骨折的疗效分析[J].中华创伤杂志，2019，35（9）：823-828.
[21] 薛飞，武剑，佟雁翔，等.经髂腹股沟入路置入顺行拉力螺钉治疗涉及后柱的复杂髋臼骨折[J].中华创伤骨科杂志，2019，21（9）：783-789.
[22] Chen J，Liu H，Wang C，et al. Internal fixation of acetabular fractures in an older population using the lateral-rectus approach： short-term outcomes of a retrospective study [J]. J Orthop Surg Res，2019，14（1）：4.
[23] Ma K，Luan F，Wang X，et al. Randomized， controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures [J]. Orthopedics，2013，36（10）：e1307-1315.
[24] 刘家国，尚峰，罗斌，等.腹直肌外侧入路钢板结合后柱拉力螺钉固定治疗涉及后柱的髋臼骨折[J].中华创伤骨科杂志，2019，21（6）：490-497.
[25] 邹如意，吴敏，官建中，等.经腹直肌旁手术入路治疗髋臼骨折的研究进展[J].中国矫形外科杂志，2020，28（4）：332-335.
[26] 陈栋，朱峰，龚杰，等.改良Stoppa与经髂腹股沟入路用于髋臼骨折的临床观察[J].中国医药导报，2021，18（3）：84-87，92.
[27] 方浩伟，陈凯宁.Stoppa入路、经髂腹股沟入路对骨盆髋臼骨折患者术后运动功能及生活自理能力的影响观察[J].中国医药科学，2020，10（8）：263-266.
[28] 邵晏清，熊然，张潇，等.改良stoppa切口入路与腹直肌外侧入路治疗合并骨盆骨折的髋臼骨折的疗效比较[J].医学综述，2016，22（2）：380-382.
京公网安备 11010502046598号