自体游离髂骨移植重建髋臼后壁陈旧性骨折缺损

目的 探讨用自体游离髂骨移植重建髋臼后壁陈旧性骨折缺损的方法。方法 手术中先去除残留的髋臼后壁骨折块,使脱位的股骨头复位,取长６～８ｃｍ、宽３～４ｃｍ的自体游离髂骨植于髋臼后壁基底处,用２～４枚螺钉固定,以重建髋臼后壁。自１９９０年３月～１９９８年３月,用此法治疗６例车祝伤患者;男４例,女２例;年龄８～４５岁,平均３２岁,全部病例从骨折至重建术的时间为３～１１个月,平均７个月,随访２～１０年。结果 无一例患者发生手术后并发症,髋关节功能均恢复良好,可不扶拐行走,轻度跛行,长距离行走后仅有轻微疼痛,Ｘ线片显示股骨头与重建的髋臼虽未达到解剖学匹配,但股骨头无再脱位,其中髋关节轻度间隙狭窄无退变者１例,间隙狭窄伴轻度退变者３例,股骨头轻度致密改变者２例,结论 自体游离髂骨移植重建术,是治疗年轻患者髋臼后壁陈旧性骨折缺     

空心螺钉治疗髋臼后壁骨折

在髋臼骨折中,髋臼后壁骨折最常见,并常伴髋关节后脱位。对关节稳定、骨折块较小患者可采取保守治疗。但对髋关节功能不稳定、骨折块较大者,应行切开复位内固定治疗。我们用空心螺钉治疗髋臼后壁骨折21例,取得较好效果。报道如下。临床资料1.一般资料:采用空心螺钉组21例,男15例,女6例,年龄20~65岁,平均40岁。受伤原因:交通伤13例,坠落伤6例,压砸伤2例。18例合并髋关节后脱位,3例合并股骨头骨折(PipkinⅡ型),15例合并四肢骨折、2例合并坐骨神经不全损伤。同期应用重建钢板治疗髋臼后壁骨折25例,男13例,女12例,年龄23~68岁,平均38.8岁。受伤…     

后壁负重区加用管型钢板治疗髋臼后壁骨折的疗效

目的 探讨后壁负重区加用管型钢板治疗髋臼后壁骨折的疗效。方法 采用传统3.5 mm纵向重建钢板固定治疗18例髋臼后壁骨折患者,在后壁负重区加用管型钢板固定。结果 患者均获得随访,时间7～21个月。术后根据Matta标准评估骨折复位质量：解剖复位12例,良好5例,差1例。术后完全负重时间10～14周。骨折均愈合,时间12～20周。术后1例因股骨头缺血性坏死导致髋关节慢性疼痛,于术后1年行髋关节置换术治疗;其余患者随访期间未发生骨折再移位、切口深部感染、螺钉穿透、内固定物松动或断裂以及下肢深静脉血栓形成等并发症。末次随访时采用改良d′Aubigne-Postal评分评价患髋功能：优9例,良6例,可2例,差1例,优良率为15/18。结论 在髋臼后壁骨折的治疗中,对累及负重区的后壁骨折块加用管型钢板固定,有利于中和该区域巨大的应力,减少内固定失效的风险,临床疗效满意。     

髋臼后壁骨折的治疗进展

后壁骨折在髋臼骨折中最为常见,为关节内骨折,所处解剖位置深在,合并伤多,治疗难度较大.影响疗效因素的多样性和术后潜在的关节病发生风险使得治疗颇具挑战性.骨折块的复位质量和坚强的内固定方式对术后功能恢复极其重要.一些新的内固定方法取得了良好的成效.本文主要对髋臼后壁骨折的治疗及其进展作一综述.     

髋臼后壁骨折并髋关节脱位手术治疗的疗效分析

目的探讨髋臼后壁骨折合并股骨头后脱位的手术治疗方法及影响预后的因素。方法本组25例患者,伤后均急诊行手法复位．多数在伤后5～7天应用Kocher—langenback切口行手术治疗,髋臼后壁骨折复位后,应用螺丝钉或加钢板内固定,必要时植骨。结果全部患者均随诊6～36个月．根据相关资料评定：X线评定结果优19例、良4例、可2例,优良率：92％。临床功能评定优13例、良8例、可3例,差1例,优良率：84％。结论髋臼后壁骨折并关节脱位解剖复位及手术内固定可提高此类损伤疗效和减少并发症发生。     

髋臼后壁骨折的手术治疗

目的探讨髋臼后壁骨折的治疗方法及疗效。方法回顾分析我科治疗的21例髋臼后壁骨折患者,男18例,女3例;年龄21～55岁,平均41岁。均采用切开复位钢板螺钉内固定。结果全部患者获得随访,随访时间13～49个月平均25.4个月。根据M atta标准评估,优16例,良4例,可1例,无感染及血管损伤,异位骨化3例。结论切开复位钢板螺钉内固定是治疗髋臼后壁骨折的有效方法。术前影像学检查、手术时机、解剖复位是影响疗效的重要因素。     

49例髋臼后壁骨折的疗效观察

髋臼后壁骨折是临床上最常见的髋臼骨折,往往并发于髋关节后脱位或合并于其他类型的髋臼骨折。本院自1992年1月至2002年1月间,共收治49例患者,现总结经验,探索其治疗方法与预后。1资料与方法1.1本组49例髋臼后壁骨折,男38例,女11例;年龄19～68岁,平均42.4岁。受伤原因:摩托车摔伤5例,汽车相撞35例,坠落伤9例。不伴脱位者13例,按Judet-Letournel分类:后壁骨折5例,后壁及后柱骨折6例,横型及后壁骨折2例。髋关节后脱位伴后壁骨折36例,按Thompson和Epstein分型:Ⅰ型(脱位伴微小骨折)12例,Ⅱ型(脱位伴有髋臼后壁的孤立大块骨折)15例,Ⅲ型(脱位…     

手术内固定治疗髋臼后壁粉碎骨折

2005年10月～2011年10月,我科对16例髋臼骨折患者采用切开复位内固定治疗,取得较好疗效,报道如下。1材料与方法1.1病例资料本组16例,男11例,女5例,年龄29～75岁。合并伤:髋关节脱位9例,股骨头骨折3例,坐骨神经损伤2例,腹腔脏器损伤2例。     

髋臼后壁骨折

髋臼后壁骨折是最常见的一种髋臼骨折。大约占所有髋臼骨折的1／4-1／3^[1,2]，Letoumd^[3]将其归为基本的髋臼骨折类型之一。后壁骨折在X线片上表现单纯，手术操作上简单，但临床疗效却不尽人意，一些学者报导手术治疗后预后不满意者约占30％^[1,4,5,6]。Epstein^[7]发现非手术治疗88％预后不良。本文对后壁骨折的有关问题作一总结，以期提高对本病的认识。     

改良髋臼后壁解剖万向覆压型固定钢板在髋臼后壁骨折中应用

目的比较改良髋臼后壁解剖万向覆压型固定钢板内固定与普通重建钢板内固定治疗髋臼后壁骨折的疗效。方法将42例髋臼后壁骨折患者分别行改良髋臼后壁解剖万向覆压型钢板内固定术(万向组,20例)与重建钢板内固定术(重建组,22例)。结果患者均获得随访,时间12～24个月。与万向组比较,重建组手术出血量多、手术时间与住院时间长,差异均有统计学意义(P 0. 05)。术后髋关节功能:重建组优14例,良5例,可2例,差1例;万向组优16例,良3例,可1例;两组疗效比较差异有统计学意义(P 0. 05)。结论改良髋臼后壁解剖万向覆压型钢板治疗髋臼后壁骨折术中螺钉固定方便、牢固,术后功能恢复好,术后并发症少,可作为髋臼后壁骨折手术治疗的选择方式。     

Use of tricortical iliac crest strut autograft in comminuted posterior wall acetabular fractures: A case series

Purpose

The results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conversion to total hip arthroplasty. The conversion to total hip arthroplasty is possible in patients over 50 years of age but not in younger patients. So this requires new methods for salvage of the native hip in young patients.

Posterior wall reconstruction using iliac crest strut graft in severely comminuted posterior acetabular wall fracture

Osteosynthesis of comminuted posterior acetabular wall fractures is a challenging task for surgeons. We report a series of eight cases of such fractures where the comminuted fragments were excised and the defect in the posterior acetabular wall was reconstructed with iliac crest strut graft. The graft was buttressed with a reconstruction plate on its posterior aspect. The patients were followed up every week until radiological signs of union were seen. Subsequent follow-up was after six months, one year and annually. Patients were evaluated clinically by Merle d’Aubigne and Postel score and radiologically by Matta score at their final follow-up. All fractures united radiologically after an average follow-up of 3.2 months. The clinical outcome after mean follow-up of 3.34 years (minimum two years and maximum five years) was as follows: two (25%) were excellent, two (25%) were very good, three (37.5%) were good and one (12.5%) was fair. Radiological grading at last follow-up showed excellent in one (12.5%), good in four (50%) and fair in three (37.5%) patients. No complication in the form of infection, heterotopic ossification, neurovascular injury or graft resorption was noticed. To conclude, excision of the small comminuted fragments and reconstruction of the wall using iliac crest strut graft is a viable alternative technique for reconstruction of the comminuted posterior acetabular wall fracture. The medium-term clinical and radiological results of this technique are satisfactory.     

The use of a structural free iliac crest autograft for the treatment of acetabular fractures

Introduction

Bone and cartilage deficits in the posterior acetabular wall are severe complications resulting from the unsuccessful management or delayed treatment of acetabular fracture. This potentially disastrous condition cannot be treated reliably with the use of reconstruction plates and screws alone. Therefore, this technical report describes a modified anatomical reconstruction method that uses a structural iliac crest autograft and an acetabular tridimensional memory alloy fixation system (ATMFS) to treat late-stage deficits in the posterior wall of the acetabulum. This paper also describes a clinical study of 22 patients with an average of 6.3 years follow-up to evaluate the clinical outcomes of this method.

Methods

Twenty-two patients, who had an acetabular reconstruction between January 2000 and December 2011 that used a structured free iliac crest autograft to treat late-stage bone and cartilage deficits in the posterior acetabular wall were followed annually with clinical and radiographic evaluations. The average age of the patients was 36.4 years at the time of the procedure, and the average time of follow-up was 6.3 years.

Results

None of the patients in this study lost reduction after surgery, and there were no cases of implant failure. Radiographic analysis using Matta’s X-ray evaluation criteria were excellent in eleven cases, good in eight, and fair on three. The Merle D’Aubigné and Postel clinical outcomes at the final follow-up were as follows: seven cases were excellent, ten cases were good, three cases were fair and two cases were poor.

Conclusions

The use of a modified iliac crest grafting and ATMFS fixation, as a biological method to reconstruct the acetabulum anatomically may offer better congruence of the joint surface and may ensure good hip joint stability during early postoperative exercise. The medium to long-term results of this method are encouraging.     

Repetitive posterior iliac crest autograft harvest resulting in an unstable pelvic fracture and infected non-union: case report and review of the literature

Fractures of the pelvic ring have been well studied, and the biomechanical relationship between the anterior and posterior elements is an important concept to understand these complex injuries. The vast majority of these injuries are due to trauma. However, in rare circumstances, autogenous bone graft harvesting may lead to an unstable pelvic ring. In this case report, we describe a rare complication in a 70-year old female patient who developed an unstable pelvis and an infected non-union secondary to repeated posterior iliac graft harvest. The orthopaedic surgeon should be aware of this detrimental complication associated with extensive or repeated posterior iliac crest graft harvest.     

Factors influencing arthrodesis rates in a rabbit posterolateral spine model with iliac crest autograft

Purpose

The rabbit posterolateral intertransverse spine arthrodesis model has been widely used to evaluate spinal biologics. However, to date, the validity and reproducibility of performance of iliac crest bone graft, the most common and critical control group, has not been firmly established. We evaluated original research publications that utilized this model, identified which experimental conditions affected fusion rates, and developed an algorithm to predict fusion rates for future study designs.

Methods

A MEDLINE search was performed for publications through December, 2011 that utilized this model to evaluate fusion rates elicited by iliac crest autograft. All study parameters were recorded, and logistic regression analyses were performed to determine the effects of these variables on fusion rates as determined by either manual palpation or radiographs.

Results

Seventy studies with 959 rabbits in 102 groups met the inclusion criteria. Excluding studies that measured fusion at 4 or fewer weeks or intentionally tried to decrease the fusion rate, the overall fusion rate for autograft was 58.3 ± 16.3 % (mean ± SD) as determined by manual palpation and 66.4 ± 17.8 % by plain radiographs. Regression analysis demonstrated a difference between these outcome measures with a trend towards significance (p = 0.09). Longer time points and larger volumes of autograft resulted in significantly greater reported fusion rates (p < 0.0001 and p < 0.05, respectively). Neither strain, age, weight, nor vertebral level significantly affected fusion rates.

Conclusions

Although experimental conditions varied across studies, time point evaluation and autograft volume significantly affected fusion rates. Despite some variability demonstrated across certain studies, we demonstrated that when the time point and volume of autograft were controlled for, the iliac crest control group of the rabbit posterolateral spinal arthrodesis model is both reliable and predictably affected by different experimental conditions.     

Free iliac crest grafts with periosteum for treatment of old acetabular defects

Objective: To inquire into the therapeutic effectiveness of free iliac crest grafts with periosteum on old acetabular defects. Methods:From February 1996 to June 2005, 9 patients were treated with free iliac crest grafts with periosteum to reconstruct old acetabular defects. There were 7 males and 2 females and the average age was 41.3 years. The acetabular defects were caused by traffic accidents in 6 cases and fall injury in 3 cases. The time from injury to treatment was 4-13 months and averaged 8 months. Intraoperatively we firstly removed the acetabular fracture fragments of the posterior wall. The femoral head was then reducted. Bone graft was harvested from the iliac crest with periosteum,which was sculpted with a rongeur to conform to the defect. The concave (iliac fossa) side of the graft was placed toward the femoral head. The graft was securedly fixed by two to three leg screws. Results:Postoperative syndrome was not found in any of the cases. Harris' score system showed that the score raised from 32. 3 points preoperatively to 81 points postoperatively. The hip function was evaluated as excellent in 3 cases,good in 4 cases and fair in 2 cases. Conclusions: Although this procedure could not exactly reproduce the anatomy of the hip joint, it enables to restore the posterior stability, provide bone-stock for the hip joints and prevent dislocation of the femoral head.