Qi Qiang, Dang Geng-cho, Chen Zhongqiang, and other computer-analytical analysis of X-ray images of the cervical spine flexion and extension range of normal Chinese. Chinese Journal of Orthopaedics 2000; Absorbable screws for the treatment of acetabular fractures in 11 cases reported that Nantong Medical College Affiliated Hospital (226001) Wang Hongcheng Red Bing is currently clinically caused by various causes of acetabular fractures. In the past, internal fixation equipment has been unable to meet the increasingly high requirements in clinical practice. In our hospital, 11 cases of acetabular fractures were treated with absorbable screws from 1999 to 2000, and satisfactory results were obtained. The report is as follows.
The clinical data were ~73 years old, with an average of 35 years; 3 cases of right hip and 8 cases of left hip. Causes of injury: 7 cases of car accident, 3 cases of fall from height, and 1 case of other causes. There were 4 cases of central dislocation of the femoral head, 2 cases of posterior dislocation, and 4 cases of femoral head fracture.
The fracture type was classified according to Letournel, 2 cases of posterior wall fracture, 4 cases of posterior column fracture, 4 cases of anterior column fracture and 1 case of anterior wall fracture. At the time of admission, the fracture was moved, and 5 cases were severely displaced by more than 10 mm. 4 cases of central dislocation of the femoral head were classified into 4 cases according to the evaluation criteria of central dislocation of the femoral head by Lu Yupu et al., 1 case of 1 degree, 1 case of 111 degree.
Therapeutic methods were performed before the routine bone traction; the postoperative limbs were fixed.
Surgical treatment (1) indications for surgical treatment are: 1 re-examination of X-ray films after 7 days of bone traction, fracture displacement > 3 mm; 2 posterior wall defects more than 40%) 3 combined with femoral head fractures; 4 joints with free bone fragments 5 displacement of the acetabular fracture (Matta top arc angle < 50 *); (2) surgical methods: routine disinfection and placement, according to the type of fracture and displacement direction to select the surgical approach. Fully expose the acetabulum, if necessary, artificially cause dislocation of the hip. Make sure that the fracture block is dissected and restored as far as possible under direct vision and C-arm X-ray machine guidance. According to the size of the fracture block, select the appropriate thickness, length and length of absorbable screws. Use a power drill and a Kirschner wire with a slightly smaller diameter than the absorbable screw to nail the broken bone piece to the pelvis and try to keep the inner surface of the acetabulum flat. Remove the Kirschner wire, tap and screw in the absorbable screw. Reset the hip joint, close the joint capsule, and place the vacuum suction to close the incision.
Results All 11 cases were followed up for a maximum of 1 year and 10 months, and the shortest was 6 months, with an average of 1 year and 2 months. The follow-up results were evaluated according to the main complaint, joint function and X-ray findings (2, 3), and were classified into three levels: satisfaction, basic satisfaction and dissatisfaction. Satisfactory: no pain in the hip joint, joint function is normal, X-ray film has no warehouse | J traumatic arthritis and femoral head necrosis; basic satisfaction: no pain in the hip joint or only mild discomfort, mild joint function, X The line shows signs of traumatic arthritis, but no femoral head necrosis; dissatisfaction: hip pain, need to take painkillers, joint function is obviously limited, X-ray film shows obvious traumatic arthritis or femoral head necrosis . 11 cases were treated with anatomical reduction (dislocation <1mm) in 5 cases, satisfactory reduction (dislocation <3mm), and unsatisfactory reduction (dislocation > 3mm) in 2 cases. During the operation, 7 cases of femoral head showed obvious gross damage.
5%) Basic satisfaction 4 cases (36.4%) Dissatisfied 6 cases (18.2%) Treatment methods The acetabular fracture is an intra-articular fracture. The purpose of treatment is the same as other intra-articular fractures, not only to return the femoral head to the hip.臼 Load the weight area, and restore the integrity of the articular surface, especially the acetabular weight bearing surface; reduce the complications of acetabular fractures. The treatment of acetabular fractures includes two methods: bone traction treatment and internal fixation. What treatment method should be used depends on the type of acetabular fracture, the degree of bone displacement, and whether or not the weight-bearing area is involved. In the past, the traction method was routinely used, and only the reduction of the femoral head was emphasized, but it was difficult to achieve an ideal reduction of the acetabular fracture, and it was difficult to maintain even if it was reset. Surgery may result in a good reduction and fixation of the acetabular fracture, which is beneficial to early joint movement and grinding, promote healing of the cartilage in the joint, and reduce complications. At present, more and more scholars at home and abroad generally support early surgical treatment (4), the surgical indications are: 1 all the fractures involving the acetabular weight-bearing top, especially those with a displacement greater than 3 mm; 2 free bone fragments in the joint cavity Patients with poor femoral head reduction; 3 fractures account for more than 40% of the posterior wall fractures of the posterior wall and posterior column fractures lead to joint instability; 4 combined with sciatic nerve injury, vascular injury needs timely surgical exploration. After the injury, the shape of the acetabulum is basically normal, the lower acetabular fractures and the anterior column and anterior wall fractures do not affect the weight-bearing top; the severely comminuted acetabular fractures, local infection, severe osteoporosis, and previous severe osteoarthrosis Non-surgical treatment is still needed for those who are not suitable for medical diseases.
In the past, commonly used cancellous bone screws, plate screws (including Le-tournel shaped steel plate), crossed Kirschner wires, etc. We believe that the above several internal fixation methods have the following shortcomings: 1 internal fixation with plate screws, long operation time, large trauma, poor long-term efficacy; 2 with crossed Kirschner wire, difficult operation, fixed fixation, Small bones can not be fixed; 3 with cancellous bone screws can achieve the same surgical results as absorbable screws, but still need to remove internal fixation after surgery, causing secondary damage to the acetabulum, affecting long-term effects. The absorbable screw is easy to operate, has short operation time, can fix small bones to restore acetabular integrity to the maximum extent, does not require secondary surgery, minimizes iatrogenic injury, and does not affect the subsequent artificial femoral head or Total hip replacement.
Prognosis analysis and countermeasures The acetabular fracture is an intra-articular fracture, and the late complications are high and serious. Traumatic arthritis and femoral head necrosis are the most important late complications, which seriously affect the quality of life of patients. Traumatic arthritis is not only related to the fracture reduction, but also closely related to the damage and location of the femoral head and acetabular cartilage and subchondral bone. The avascular necrosis of the femoral head is related to the different degrees of damage of the femoral head and the blood supply disorder of the internal capsule of the hip joint. ()) For such patients, artificial femoral head or total hip replacement can be performed according to different conditions.
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