| Complex acetabulum fractures often occurred in young adults by high-energy injures. Conservative treatment usually adapted to the no obvious shift, for the significant shift (>3mm), non-operative therapy effect is poor, especially with square area fractures, conservative treatment may be the legacy of traumatic sex arthritis and other serious complications caused by dysfunction of the hip. For this type of fracture, at present, most scholars advocated that joint function need be maximize recovered by joint into the approach of ilioinguinal approach and Kocher-langenbeck approach to achieve the anatomical reduction and internal fixation by double column titanium plates, but it has large exposure injury, long operation time, blood loss, postoperative infection. In recent years, our hospital had treatment of complex acetabulum fracture by trans-plate quadrilateral screws system combined with posterior column screws-anterior special shape reconstruction plate and trans-plate quadrilateral screws combined with posterior column lag screws. It not only reach effective reduction and fixation for fracture, but also reduce the surgical trauma, shorten the operation time, reduce the complications. First of all, this study uses three-dimensional finite element method to explore trans-plate quadrilateral screws system combined with posterior column screws’ biomechanical properties at standing, sitting and standard gait, to provide necessary biomechanical basis for clinical application. Secondly, further evaluation the clinical effect of trans-plate quadrilateral screws system combined with posterior column screws internal fixation for complex acetabulum fracture by retrospective analysis and comparison.Objective:Establish an effective three-dimensional finite elem ent model of normal pelvic. Using three-dimensional finite elem ent method to evaluate the biomechanical stability of trans-pla te quadrilateral screws system combined with posterior column s crews internal fixation surgery in treatment of quadrilateral plate fractures of the complex acetabulum and to compare the cl inical effect of anterior and posterior double column titanium plate and trans-plate quadrilateral screws system combined wit h posterior column screws in the treatment of complicated acet abular fractures. Than provide a reliable, effective way of int ernal fixation for this kind of complex acetabulum fractures.Methods:The first, normal pelvic three-dimensional finite elem ent model is established by using the finite element modeling s oftware and verified to prove its effectiveness. The second, do uble column fracture model is builded which is the most represe ntative of quadrilateral plate fractures of the complex acetabu lum. Than simulating double column titanium plate (A), anter ior special reconstruction titanium plate plus quadrilateral plate screws (B) and trans-plate quadrilateral screws system co mbined with posterior column screws (C)internal fixation surger y in treatment of the fracture. Finally, the finite element ana lysis for the biomechanical stability of three kinds of interna l fixation sat standing, sitting and standard gait under normal load. Than, retrospective analysis of56cases complex acetabu lar fracture patients which were treated from2006February to2013February. The patients were divided into two groups accor ding to the surgical options:group1is the combined approac h operation group:35cases, male19cases, female16cases, average (39.8±7.2) years, with combined anterior and posterio r approach open resetting double column titanium plate intern al fixation. Group2is anterior approach operation:21case s, male13cases, female8cases, average (41.2±5.3) years old, with anterior open resetting trans-plate quadrilateral sc rews system combined with posterior column screws internal fixa tion. Two groups were compared of intra-operative situation, a cetabular resetting situation, hip joint function at last time follow-up and the incidence of postoperative complications.Results:1. Respectively simulated in standing and sitting, compared the acetabular fossa maximum force and maximum displacement of these three kinds of internal fixation under t he same loading method. The model internal fixed by trans-plate quadrilateral screws system combined with posterior column scr ews is minimum. In addition, compared the fracture line mean no de displacement, The model internal fixed by trans-plate quadri lateral screws system combined with posterior column screws is minimum also, but there is no statistical significance (P>0.05).2. In different gait, comparison of three internal fixation wi th normal model, each node average displacement size of fractur e line is C<B<normal model<A. By statistical analysis, when h ip joint goes to extension4°and flexion18°, it has signif icant differences between A and C internal fixation. When hip j oint goes to extension12°and14°, there were statistically significant difference between A and B, C internal fixation (p<0.05). No statistically significant difference between the rest comparison (p>0.05).3.56postoperative patients were followe d up for good. Combined approach operation group and anterior approach group operation time were (249.4±34.5)min and (190.2±22.2)min; intra-operative blood loss were (875±153.6)ml and (540.2±169.6)ml; the hip function scores were (15.66±1.98) and (16.16±1.89) at the last time follow-up according to the m odified Merled’ Aubigne-Postel scoring system, the incidence of complications were40%and14.3%All of above have statis tical significance (P<0.05). Anatomic resetting rate were82.9%and66.7%, according to Matta resetting standard assessing f racture, with no statistical significance (P>0.05).Conclusion:The finite element modeling can effectively reflec t the pelvic stress distribution. Analysis results showed tha t trans-plate quadrilateral screws system combined with posteri or column screws for the treatment of acetabular fractures invo lving of the quadrilateral area has good biomechanical stabilit y. It can gain small trauma, reliable fixation, the low rate of complications, satisfactory clinical effect, which is a clinic al reliable fixed way can choose to handle such fractures. |
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