| Objective:The purpose of this study is providing theoretical evidences for an intelligent surgical plan of acetabulum fractures involving quadrilateral plate by evaluating different surgical times,surgical approaches,internal fixation types and complications as well as their influences on the final effects of treatment.Methods:Patients with acetabulum fracture involving the quadrilateral plate who were treated in our department between January 1,2012 and December 31,2015 were involved in this study.According to include and exclude standards,totally 73 cases were involved including 4 cases were lost of follow-up and 1 died within 3 months after operation.Of the 68 available cases,51 were male,while 17 were female.The average age was 43.7±13.1,ranging from 22 to 73.The injury mechanisms of the 68 cases were 33 cases of traffic accidents,27 cases of high fall injury,4 cases of crush injury,3 cases of falls and 1 case of heavy injury.According to Letournel-Judet’s classification of acetabular fractures,there were 14 cases of transverse fracture,20 cases of both-column fracture,13 cases of T-shaped fracture,10 cases of transverse and posterior wall fractures,7 cases posterior column and posterior wall fractures and 4 cases of anterior column and hemitransverse fractures,respectively.The surgical timing,surgical approach,internal fixation and complications of these cases and their influence on the treatment effects were discussed.In order to determine the influence of surgical timing for treatment effect of acetabulum fractures,all the patients were divided into two groups according to the time interval between trauma and operation.Cases with interval less than 14 days were regarded as early surgery group.And cases with interval more than 14 days were regarded as late surgery group.In terms of surgical approach,19 cases were treated via illioinguinal approach,21 cases were treated via Kocher-Langenbeck approach and 28 cases were treated via combined surgical approaches.In terms of internal fixation,50 cases were fixed with reconstruction plates,14 cases were fixed with anterior column reconstruction plates plus posterior column hollow tension screws,while the rest 4 cases were fixed with anterior column hollow tension screws plus posterior column reconstruction plates.Results:The average and median time interval between trauma and operation were 16.0±9.3 days,13(9~21)days,respectively,ranging from 3 to 42 days.All the acetabulum fractures were healed.The average time interval between operation and healing was 12.5 weeks.According to the rating by Matta,anatomical reduction was achieved in 31 cases,satisfactory reduction was achieved in 27 cases,unsatisfactory reduction in 10 cases.The mean follow-up time was 28.9 months,ranging from 12 to 59 months.According to Harris hip joint function score,31 cases achieved excellent,19 cases achieved good,13 were fair and 5 were poor at the last follow-up.Statistical analysis about surgical timing showed that there were no significant differences of age,gender,mechanisms of injury and acetabulum fracture classification between the two groups.The differences of basic health levels,pelvic fractures,lower extremity fractures and abdominal visceral injury between the two groups were also not significant(P>0.05).The ISS of the early surgery group(15.0±4.8)was significant lower than that of the late surgery group(20.1±6.3)(P<0.001).In the early surgery group,two cases were combined with craniocerebral injuries and 8 cases were combined with thoracic injuries,which were significant less than those in the late surgery group(P<0.05),in which 10 cases combined with craniocerebral injuries and 17 cases combined with thoracic injuries.According to the Matta rating,the patient satisfaction rate of early surgery group was 89.5%,which was significant higher than that of late surgery group(80.0%)(P<0.05).According to Harris hip joint function score,the good to excellent rates early surgery group was 84.2%,which also higher than that of late surgery group(60%)(P<0.05).The incidence of lower extremity deep vein thrombosis(DVT)of the early surgery group was significant less than that of the late surgery group(P<0.05).Statistical analysis about surgical approach showed that there were no significant differences of age,gender,injury mechanisms and ISS between the three groups(P>0.05).The acetabulum fractures Letournel-Judet classification were significant different between the three groups(P<0.01).The differences of fracture reduction quality and Harris scores between the three groups were not significant(P>0.05).Statistical analysis about internal fixation showed that there were no significant differences of age,gender,injury mechanisms and ISS between the three groups(P>0.05).There was significant difference of Letournel-Judet classification between the three groups(P<0.05).The differences of fracture reduction quality and Harris scores between the three groups were not significant(P>0.05).Conclusion:Early surgery treatment of acetabulum fractures involving the quadrilateral plate could improve reduction quality and hip joint function recovery of post-operation.The main factor influencing the time interval between trauma and operation is the injury severity of the patients,especially in patients combined with craniocerebral injuries and thoracic injuries.Early surgery can reduce the patient’s preoperative complications,especially the incidence of lower extremity DVT.The main factor influencing the surgical approach and internal fixation is acetabulum fracture type.Therefore,patients combined with craniocerebral injuries and thoracic injuries should be treated as soon as possible.At the same time,an intelligent plan should be prepared before operation once the patient was in a stable condition.When making operation plan,we should select the appropriate surgical approach and internal fixation according to acetabulum fracture classification and habit of surgical doctor in order to achieve an anatomical reduction and a better function. |
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