ASSOCIATED POSTERIOR PELVIC INJURY PATTERNS IN TRANSVERSE-ORIENTED ACETABULAR FRACTURE

ABSTRACT Objective: Our study analyzed the incidence of posterior pelvic injury patterns and their influence on the surgical treatment of transverse-oriented acetabular fractures . Methods: Fifty-one transverse-oriented acetabular fracture cases admitted between 1999 and 2013 were evaluated retrospectively. Comparative studies were performed for groups organized by acetabular fracture type, degree of sacroiliac separation, and postoperative reduction quality . Results: Associated posterior pelvic injuries were found in 34 (66.7%) of the 51 patients. There were 32 sacroiliac separations in the 34 patients with associated posterior pelvic injury, and ipsilateral sacroiliac separations were more frequent in this subgroup. Measurements guided by computerized tomography showed that 16 sacroiliac separations were ≤0.5 cm (mean=0.43±0.14 cm), 10 were 0.5-1 cm (mean=0.73±0.17 cm), and the remaining 6 were >1 cm (mean=1.55±0.15 cm). In the group of 34 patients with associated posterior pelvic injury, acetabular reduction was anatomic in 19 (55.9%) patients, imperfect in 10 (29.4%) patients, and poor in 5 (14.7%) patients. For isolated acetabular fractures, reduction rates were as follows: 12 (70.6%) anatomic, 3 (17.6%) imperfect, and 2 (11.8%) poor. The rate of anatomic reduction was significantly higher when sacroiliac separation was ≤0.5 cm (p=0.027) . Conclusion: Associated posterior pelvic injuries, especially ipsilateral sacroiliac joint separation, accompany most transverse-oriented acetabular fractures and may influence the quality of acetabular reduction. Level of Evidence III, Therapeutic Studies Investigating the Results of Treatment.

摘要 研究目的：本研究旨在分析横行型髋臼骨折（transverse-oriented acetabular fractures）合并骨盆后侧损伤（posterior pelvic injury）的发生率，及其对该类骨折手术治疗的影响。方法：回顾性分析1999年至2013年间收治的51例横行型髋臼骨折病例，根据髋臼骨折类型、骶髂关节分离（sacroiliac separation）程度以及术后复位质量分组开展对比研究。结果：51例患者中，34例（66.7%）合并骨盆后侧损伤。合并骨盆后侧损伤的34例患者中共存在32处骶髂关节分离，该亚组中同侧骶髂关节分离更为常见。经计算机断层扫描（computed tomography，CT）测量显示，16处骶髂分离宽度≤0.5cm（平均0.43±0.14cm），10处在0.5~1cm之间（平均0.73±0.17cm），剩余6处＞1cm（平均1.55±0.15cm）。在合并骨盆后侧损伤的34例患者中，髋臼解剖复位19例（55.9%）、复位不良10例（29.4%）、复位不佳5例（14.7%）；对于单纯髋臼骨折病例，复位情况分别为解剖复位12例（70.6%）、复位不良3例（17.6%）、复位不佳2例（11.8%）。当骶髂关节分离≤0.5cm时，解剖复位率显著更高（p=0.027）。结论：合并骨盆后侧损伤（尤其是同侧骶髂关节分离）多见于多数横行型髋臼骨折病例，并可能对髋臼复位质量产生影响。证据等级：Ⅲ级，治疗效果相关治疗性研究。