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  • Title: [Experiences with the infra-acetabular screw placement technique in acetabular fracture surgery].
    Author: Wu M, Guan J, Chen X, Wang X, Zhao P, Li R, Chen J, Liu L.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Sep 15; 38(9):1040-1046. PubMed ID: 39300876.
    Abstract:
    OBJECTIVE: To investigate the application experiences and effectiveness of the infra-acetabular screw (IAS) placement technique in acetabular fracture surgery. METHODS: A clinical data of 34 patients with complex acetabular fractures with anterior and posterior columns separation, who were admitted between January 2019 and October 2023 and treated with IAS fixation, was retrospectively analyzed. There were 23 males and 11 females with an average age of 55.3 years (range, 18-78 years). The acetabular fractures caused by traffic accident in 20 cases, falling from height in 12 cases, crushing injury in 1 case, and bruising with a heavy object in 1 case. According to the Letournel-Judet classification, there were 7 cases of anterior column fracture, 8 cases of anterior wall/column plus posterior hemi-transverse fracture, 2 cases of T-shaped fracture, and 17 cases of both-column fracture. The time from injury to surgery was 4-21 days (mean, 8.6 days). The time of IAS placement and the intraoperative blood loss were recorded. After surgery, the X-ray film and CT scan were re-examined, and the modified Matta score was used to assess the quality of fracture reduction. The trajectory of IAS in the channel was analyzed based on CT scan, and the screw length was measured. During follow-up, the fracture healing was observed and the hip function was assessed according to the modified Merle d'Aubigné-Postel scoring system at last follow-up. RESULTS: The IAS was successfully implanted in all 34 patients. The length of IAS ranged from 70 to 100 mm (mean, 86.2 mm). The time of IAS placement ranged from 10 to 40 minutes (mean, 20.7 minutes). The intraoperative blood loss ranged from 520 to 820 mL (mean, 716.8 mL). All patients were followed up 8-62 months (mean, 21.8 months). After surgery, 4 patients developed lateral femoral cutaneous nerve injury, 2 developed popliteal vein thrombosis of the lower extremity, 3 developed incision infection, and no surgical complication such as arteriovenous injury or obturator nerve palsy occurred. At last follow-up, the hip function was rated as excellent in 14 cases, good in 13 cases, fair in 4 cases, and poor in 3 cases according to the Merle d'Aubigné-Postel scoring system, with an excellent and good rate of 79.41%. Imaging re-examined showed that the quality of fracture reduction was rated as excellent in 9 cases, good in 19 cases, and poor in 6 cases according to the modified Matta score, with an excellent and good rate of 82.35%; and 25 (73.53%) IAS trajectories were located in the channel. All fractures obtained bony union, and the healing time was 12-24 weeks (mean, 18 weeks). During follow-up, there was no loosening or fracture of the plate and screws. CONCLUSION: IAS placement technique can effectively strengthen internal fixation and prevent fracture re-displacement, making it a useful adjunct for treating complex acetabular fractures with anterior and posterior columns separation. 目的: 总结髋臼下螺钉（infra-acetabular screw，IAS）植入技术在髋臼骨折手术中的应用经验及疗效。. 方法: 回顾分析2019年1月—2023年10月收治并采用IAS治疗的34例前、后柱分离的复杂髋臼骨折患者临床资料。男23例，女11例；年龄18～78岁，平均55.3岁。致伤原因：交通事故伤20例，高处坠落伤12例，挤压伤1例，重物砸伤1例。髋臼骨折Letournel-Judet分型：前柱骨折7例、前柱伴后半横型骨折8例、T型骨折2例、双柱骨折17例。受伤至手术时间4～21 d，平均8.6 d。术中记录IAS植入时间及出血量。术后复查X线片及CT，采用改良Matta评分评价骨折复位质量，评估IAS在通道内轨迹并测量螺钉长度，随访期间观察骨折愈合情况；末次随访时采用改良Merle d’Aubigné-Postel评分系统评估髋关节功能。. 结果: 34例患者术中均顺利植入IAS；IAS长度为70～100 mm，平均86.2 mm；植入时间10～40 min，平均20.7 min。术中出血量520～820 mL，平均716.8 mL。患者均获随访，随访时间8～62个月，平均21.8个月。术后4例出现股外侧皮神经损伤表现，2例发生下肢腘静脉血栓形成，3例发生切口感染；均无下肢动静脉损伤、闭孔神经麻痹、腹股沟疝等手术并发症发生。末次随访时，髋关节功能根据改良Merle d’Aubigné-Postel评分系统，获优14例、良13例、可4例、差3例，优良率79.41%。影像学复查示，骨折复位质量根据改良Matta评分达优9例、良19例、差6例，优良率82.35%；25枚（73.53%）IAS轨迹全程位于通道内。骨折均达骨性愈合，愈合时间12～24周，平均18周。随访期间无内固定钢板及螺钉松动、断裂发生。. 结论: 采用IAS植入技术能有效增加内固定强度，防止骨折再移位，可作为治疗前、后柱分离的复杂髋臼骨折的一种有效辅助手段。.
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