| Objective:The purpose of this study is was to evaluate whether fragment area of acetabular posterior wall (AO/OTA 62-Al) have an effect on hip joint functional outcome and the choose of treatment strategy.Methods:Between January 2004 and January 2015, there were 127 patients with simply acetabular posterior wall fractures in our traumatic orthopedics department were treated by conservative treatment or surgery. Among them, there are 112 patients with compelte clinic data. These patients were divided into two groups base on treatment method. The surgical group were divided into four subgroups:group A (12 cases, average age was 37.23±8.37 years), group B(21 cases, average age was 47.78±10.37 years), group C(28 cases, average age was 49.25±14.75 years), group D(26 cases, average age was 43.45±9.83 years), base on the percentage of Residual area of Posterior wall measured and calculated by CT:> 80%,60%-80% 40%-60%,<60%. Among the all 54 patients (a<60%),30 patients refused autogenous bone grafting (group X, average age was 41.65±11.24), and 24 patients were treated with autogenous bone block graft (group Y, average age was 44.82± 13.68). The non-operative group were divided into two subgroups:group E (11 cases, average age was 39.15±12.20years) and group F(14 cases, average age was 48.50± 11.25 years),base on the percentage of fragment measured and calculated by CT:> 80%,60%-80%. The time of operation, intraoperative blood loss, postoperative complications, good and excellent rate and rate of secondary surgery for all groups were compared. The clinical assessment was based on a modified Merle d’Aubigne and Postel scoring. The radiographs were graded according to the Matta criteria.Results:(1) According to the modified Merle d’Aubigne and Postel criteria, the average score of A group was 16.4±1.2, the rate of excellent and good was 91.67% (11/12); the average score of B group was 15.2±0.5, the rate of excellent and good was 95.24%(20/21); the average score of C group was 14.5±1.9,the rate of excellent and good was 85.71%(24/28); the average score of D group was 14.0±2.7,the rate of excellent and good was 84.62%(22/26);the average score of X group was 14.1±2.8, the rate of excellent and good was 80.00%(24/30);the average score of Y group was 16.2±0.5, the rate of excellent and good was 91.67%(22/24); the average score of E group was 15.7±1.1, the rate of excellent and good was 90.90%(10/11); the average score of E group was 14.8±1.2, the rate of excellent and good was 78.57%(11/14). The functional score of four surgical group (A、B、C、D) show descending trend and there were significantly differences (P<0.05). The functional score between group A and group E were not significantly differences (p>0.05). The functional score between group B and group F were significantly differences (p<0.05).The functional score between group X and group Y were significantly differences (p<0.05).(2) For Matta radiological results, the rate of excellent and good in A group was 91.67%(11/12). The rate of excellent and good in B group was 90.48%(19/21). The rate of excellent and good in C group was 85.71%(24/28). The rate of excellent and good in D group was 84.62%(22/26). The rate of excellent and good in X group was 86.67%(26/30)The rate of excellent and good in Y group was 91.67%(22/24) There were not significantly differences (P>0.05) in all groups.(3) The rate of complications and secondary surgery between group A and E were not significantly differences (P>0.05). For B group and Y group, the rate of complications and secondary surgery were both in significantly lower than those for F group and X group (P<0.05).(4) The general information between all groups were not significantly differences (P>0.05).Conclusions:(1)The hip joint functional outcome has a correlation with the percentage area of residual of posterior wall, the bigger of percentage area, the better of clinic outcome. (2) The percentage area is one of the key factor in choosing the treatment strategy. |
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