| Objective:To explore the more effective internal fixation of posterior wall of acetabular fractures,especially comminuted fracturesMethods:From March 2019 to August 2022,the orthopedic department of trauma(pelvic acetabular group)of the Second Clinical Hospital of Shanxi Medical University was collected,and the clinical data of patients with posterior acetabular posterior wall fractures were clearly diagnosed,and they were followed up after surgery.For 30 patients who met the nanodischarge criteria,they were divided into experimental and control groups according to their methods of internal fixation.The experimental group used the posterior wall of the acetabular anatomical locking plate combined with T spring steel plate for fixation,a total of 14 cases,and the control group used the posterior wall of the acetabular anatomical locking plate combined with hollow pull screw,a total of 16 cases.By collecting and analyzing the general clinical data,perioperative data and postoperative follow-up data,the quality of fracture reduction during and during the Matta scoring criteria,and the recovery of the hip was evaluated from two different aspects according to the hip Harris scoring criteria and the last improved Merle D’Aubigne-Postel scoring system.Results:All patients were successfully completed by the same surgical team.In terms of gender,male dominance was dominant.In terms of injuries,traffic injuries were the most,followed by falling from height and heavy objects.The duration of injury to surgery in the experimental group was longer(8.93 ± 4.39 days)compared with the control group(6.31 ± 3.46 days),but P> 0.05,the difference was not statistically significant.Compared with the operation duration of the two groups,the experimental group(127.64 ±40.39min)was shorter than the control group(130.06 ± 71.17min),but P> 0.05,the difference was not statistically significant.In addition,the intraoperative bleeding and postoperative drainage in the experimental group were less than the control group,but P > 0.05,and the difference was not statistically significant.However,this study found that in the two groups,the hospitalization length of the experimental group(18.86 ± 6.69days)was longer than the control group(12.63 ± 5.21 days),P <0.05,a statistically significant difference.During the follow-up of the study,the postoperative complete weight-bearing time(12.00 ± 1.66 weeks)was shorter than that in the control group(13.81 ± 2.37 weeks),And P <0.05,The difference was statistically significant;at the same time,Patients had higher hip Harris scores at 1 month(62.07 ± 6.17 points)and 3 months(72.93 ± 8.04points)than the control group(56.19 ± 8.83 points)and(67.06 ± 7.53 points),All P-values were <0.05,The difference was statistically significant,While at 6 months after surgery,The Harris score and the last modified Merle D’Aubigne-Postel score of the control group were higher,But with a P> 0.05,The difference was not statistically significant,It suggests that the recovery of early postoperative hip function in the experimental group was better than that in the control group.In addition,during the follow-up,two control patients developed the heterotopic ossification,one of which was mild,and the other patient had severe heterotopic ossification,and only one patient had mild ossification of the heterotopic ossification in the experimental group.Conclusion:For acetabular posterior wall fracture,especially comminuted fracture patients,through Kocher-Langenbeck(K-L)approach using the acetabular posterior wall anatomy locking plate combined with T spring steel plate elastic fixation of the acetabular posterior wall is more in line with the biomechanical morphology of the acetabular posterior wall,so that patients can earlier affected limb bearing and ground function exercise,in order to achieve good recent effect. |
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