| BackgroundDue to the rapid development of China’s economy in recent years,people’s living standards have improved and the pace of life has accelerated.suffer from acetabular fractures due to high-energy injuries.Except for the simple fractures such as the anterior and posterior walls of the acetabulum,most of the other acetabular fractures spread to quadrilateral plate.Many scholars have shown that through the acetabular quadrilateral plate fracture open reduction and internal fixation to restore the head-acetabulum matching relationship,the smoothness of the articular surface is the important condition which may enable patients to obtain better postoperative hip function recovery.Because of the high energy to cause trauma,the fractures involving the acetabular quadrilateral plate are usually comminuted fractures,and the fracture fragments are mostly displaced into the pelvic cavity.Sometimes,central dislocation of the femoral head may even be caused by powerful violence.,and the bone in the quadrilateral plate is thinner.The complicated anatomy and proximity to important nerve vessels make it difficult to expose and reduction intraoperatively.In addition,it is very difficult to fix the quadrilateral plate for internal fixation.For central dislocation of the femoral head,because of the compression force from the femoral head upwards and inwards,the fracture of the acetabular quadrilateral plate is difficult to be reduced and be maintained.Therefore,surgeons from orthopaedic trauma hsve been puzzled by the treatment of acetabular quadrilateral plate fractures..Orthopedists always pursue the goal that,through a single approach,acetabular quadrilateral plate fractures is effectively fixed.In recent years,Prof.Cai Xianhua of the Department of Orthopaedics of our hospital proposed and used the Dynamic Anterior Plate-screw System for Quadrilateral area(DAPSQ)for the first time.The rim-arrogant-suprapubic pedicles for the treatment of acetabular fractures involving a quadrilateral plate were placed on the plate.Due to the use of a unique multi-point elastic internal fixation on the osseous surface in the quadrilateral plate,the internal fixation system was extremely safe.No screws were inserted into the hip joint and the internal fixation was reliable.After follow-up,the patient achieved satisfactory results.Wu Yude et al.conducted a biomechanical study on the stability of the internal fixation system for the treatment of fractures in the acetabular quadrilateral plate.Experiments have shown that the DAPSQ internal fixation system has better biomechanical stability than other internal fixation systems.The acetabular morphology is the basis for the stability of the hip joint and its normal motor function.For acetabular fractures,anatomical reduction is the basis for the recovery of hip function.At present,the imaging evaluation of acetabular fractures after clinical use is the Matta evaluation standard.This evaluation standard uses the residual displacement distance to determine the superior,good,and poor.Because the evaluation criteria only involved fracture alignment and did not consider the rotational displacement of fractures,there were obvious defects.The Matta criteria evaluated the hip joint function in patients with excellent reduction quality was not necessarily satisfactory.There was no relevant evaluation for rotational displacement in the quadrilateral plate.rotation standard,quadrilateral plate shift will cause the loss of acetabular fractures anatomic reduction,the impact head and acetabulum matching relations,the future ipsilateral hip and the knee joint degeneration accelerated.For clinical needs,it is very important to find out the indexes that can be used to evaluate the rotation of the square after acetabular fracture,and further improve the imaging evaluation of acetabular fracture after surgery.To this end,based on the criteria of the Matta,we selected the original complete pelvis image from CT scan in our hospital and established a pelvic 3D model with digital medical software to perform an anatomical measurement on the acetabular square and observe the acetabular quadrilateral plate.The angle of inclination and its changes were collected in follow-up cases in this hospital.The pelvic CT three-dimensional reconstruction after acetabular square fractures was used to analyze the clinical efficacy of the Matta evaluation criteria and the modified Matta evaluation criteria.The former evaluated the quality of reduction from the perspective of alignment.The latter evaluated the quality of reduction from the point-to-line perspective,and compared and analyzed the Matta evaluation criteria and the modified Matta evaluation criteria to evaluate the superiority of the modified Matta evaluation criteria.Part one Digital measurement of the inclined angle of acetabular quadrilateral plate and its clinical significanceObjectiveThrough digital measurement and statistical analysis,the inclined angle of the acetabular quadrilateral plate in normal adults is studied to explore its role in postoperative imaging evaluation of fractures,and to lay the foundation for evaluation of postoperative rotational displacement of the acetabular quadrilateral plate,and to provide theoretical basis for the improvement of the Matta standard.MethodsCollected in our hospital underwent CT scan and three-dimensional reconstruction of the normal adult pelvis DICOM format(20 cases of male and female,mean age 44.2 years),will collect the data in DICOM format by Mimics 10.01 software,3D reconstruction using the software,the removal of the surrounding soft tissues and bilateral femur 3D digital pelvic model the "3 line" divides the acetabular partition according to pelvic bony landmarks positioning area ofquadrilateral angle,using the Mimics software of the angle measuring function were measured,and compared with the quadrilateral plate of inclination of men and women.ResultsThere is an inclined angle in the quadrilateral plate;Anteversion inclination angle of quadrilateral plate,male:97.11°±2.5° F:90.63°±2.09°.Intermediate inclination angle of quadrilateral plate,male:105.570°±93°F:100.64°±2.46°.Rear inclination angle of quadrilateral plate,male:112.62°±2.54°F:106.37°±2.53°.There is a statistical difference between the data of inclined angles of the same quadrilateral plate(P<0.05),and The front,middle,and rear angles of the same quadrilateral plate gradually increase from the front to the rear。ConclusionsThere is an inclination angle in the quadrilateral plate,which can be used to observe the line quality after fracture in the quadrilateral plate,and there is a gender difference.The front,middle and rear inclined angles of the quadrilateral plate gradually increase from front to rear.The inclined angle of the quadrilateral plate can be used to evaluate the acetabulum.The rotational displacement of the square area after fracture treatment provides the basis for making up for the lack of the Matta evaluation criteria.Part two Clinical application of acetabular quadrilateral plate inclined angle in the evaluation of the reduction quality after the operation of fracture involving quadrilateral plateObjectiveThe Malta evaluation criteria and Matta evaluation criteria plus the inclined angle of the acetabular quadrilateral plate are used to evaluate the quality of fracture reduction in the acetabular quadrilateral plate to compare their respective postoperative hip functional activity rate,and to investigate the acetabular quadrilateral plate inclined angle is used to evaluate the feasibility of the reduction quality after the operation of fracture involving quadrilateral plate.MethodsA retrospective study of 125 patients with acetabular fractures in our hospital from June 2009 to March 2018,including 74 males and 51 females;aged 22 to 71 years,mean 45.6 years.There were 82 cases of car accident injury,39 cases of fall injury at high altitude,and 4 cases of weight injury.According to Letoumel-Judet classification:81 cases of simple fractures,44 cases of complex fractures;all are closed fractures.All patients underwent open reduction and internal fixation with standard iliac inguinal approach.All postoperative acetabular fractures were evaluated for postoperative pelvic CT three-dimensional reconstruction.This study first evaluated 125 cases with Matta criteria.Evaluation results The measurement of the front,middle and rear inclined angles of the quadrilateral plate was completed to improve the evaluation of the line after fracture in the quadrilateral plate.The measurement method was referred to in the first part,and the Matta standard was analyzed to evaluate the reliability of the Matta standard.That is,Matta standard + quadrilateral plate inclined angle.If it can be verified through the use of Matta standard + quadrilateral plate inclined angle evaluation of patients with acetabular quadrilateral plate fracture after hip joint function activity rate was significantly higher than the Matta standard evaluation group,can prove Matta The standard + quadrilateral plate inclined angle is indeed better than the Matta evaluation criteria.According to the results of the evaluation and integrated with the Matta criterion,the Matta standard + quadrilateral plate inclined angle was divided.Excellent,good,poor three levels.If the case of Matta was rated as excellent,the first half and the second half of the quadrilateral plate were evaluated.The inclined angles of the front,middle and rear sides of thequadrilateral plate were all within the range,indicating that the first half and the second half of thequadrilateral plate are all in good alignment.The inclined angle is evaluated as excellent;if the front half is abnormal,the rear half is normal,that is,the front and middle inclined angles of thequadrilateral plate are abnormal and the rear inclined angle is normal,or if the rear half is abnormal,the first half is normal.,that is,if the quadrilateral plate and the rear inclined angles are abnormal and the front inclined angle is normal,the evaluation is good;if the quadrilateral plate,the front,middle,and rear inclined angles are not within the range,then the first half and the second half of the quadrilateral plate are correct Line difference,then evaluated as poor.Other grades(including good and bad)are also evaluated in this way.Then the Matta evaluation results are reclassified according to the result of the quadrilateral plate inclined angle(ie,the modified Matta evaluation criteria).That is to say,both of the two items are rated as excellent,and the Matta and the inclined angle are only excellent or the two are good and good.One or two items that are poor are considered poor.Comparison of hip function evaluation:First Harris score was performed according to the case of Matta evaluation,and then functional evaluation was performed according to modified Matta evaluation criteria to compare whether there was a difference between the two.Results1.Matta evaluation criteria were excellent in 101 cases,among which there were 37 cases of excellent inclined angle in the quadrilateral plate,good in 34 cases,poor in 30;good in 18 cases,among which there were 6 cases of quadrilateral plate inclined angle,5 cases of good,7 cases of poor,and 6 cases of poor.Among them,there are 1 case of quadrilateral plate angle,2 cases of good,and 3 cases of poor.The improved Matta evaluation criteria after the quadrilateral plate inclined angle was excellent in 37 cases,good in 76 cases,and poor in 12 cases.2.Hip function evaluation and comparison:In the Matta evaluation criteria,there were 101 cases of excellent inclined angle,of which there were 51 cases of excellent hip function evaluation,20 cases of good,19 cases of general,and 11 cases of poor;18 cases of good,of which the evaluation of hip function was excellent 7 Cases,good in 4 cases,general in 4 cases,poor in 3 cases;poor in 6 cases,of which hip function evaluation was excellent in 1 case,good in 2,fair in 1 and poor in 2 cases.The improved Matta evaluation criteria after adding the:inclined angle was excellent in 37 cases,of which hip function evaluation was excellent in 24 cases,good in 5 cases,fair in 4 cases,poor in 4 cases;good in 76 cases,among which there were excellent 29 cases of hip function evaluation There were 27 cases in good condition,11 cases in normal condition,9 cases in poor condition,and 12 cases in poor condition.Among them,there were 2 cases of excellent hip function evaluation,1 good,2 normal,and 7 poor.There was a statistically significant difference between the two groups(P<0.05).The rate of excellent and good hip functional activity was significantly higher in the acetabular quadrilateral plate fracture patients evaluated by the Modified Matta evaluation criteria after adding the inclinedangle than in the Matta standard evaluation group.ConclusionThe existence of the acetabular quadrilateral plate inclined angle is one of the important signs of the result.It can be used to evaluate the accurate rate of the widely used Matta evaluation standard after the operation of fracture involving quadrilateral plate,and it is closer to the true state of postoperative reduction.In the application of CT three-dimensional reconstruction to evaluate the reduction quality after the operation of fracture involving quadrilateral plate,the modified Matta evaluation criteria is superior to the Matta evaluation criteria.It not only considers the alignment in the fracture but also further considers the fracture alignment,making up for the lack of the Matta evaluation criteria. |
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