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：本研究分析了骨盆后损伤的类型发生率及其对横行髋臼骨折（transverse-oriented acetabular fractures）手术治疗的影响。方法：回顾性分析1999年至2013年间收治的51例横行髋臼骨折病例，根据髋臼骨折类型、骶髂关节分离（sacroiliac separation）程度及术后复位质量进行分组对照研究。结果：51例患者中，34例（66.7%）合并骨盆后损伤。34例合并骨盆后损伤的患者中共存在32处骶髂关节分离，该亚组中同侧骶髂关节分离更为多见。计算机断层扫描（Computerized Tomography）测量显示，16处骶髂分离≤0.5cm（平均0.43±0.14cm），10处介于0.5~1cm之间（平均0.73±0.17cm），剩余6处＞1cm（平均1.55±0.15cm）。在34例合并骨盆后损伤的患者中，髋臼解剖复位19例（55.9%）、复位欠佳10例（29.4%）、复位不良5例（14.7%）；而单纯髋臼骨折组的复位情况为：解剖复位12例（70.6%）、复位欠佳3例（17.6%）、复位不良2例（11.8%）。当骶髂分离≤0.5cm时，解剖复位率显著更高（p=0.027）。结论：合并骨盆后损伤，尤其是同侧骶髂关节分离，多见于绝大多数横行髋臼骨折病例，且可能影响髋臼复位质量。证据等级：Ⅲ级，治疗结局相关治疗性研究。