The Clinical Application Of Spike Plate In The Treatment Of Comminuted Fractures Of The Posterior Wall Of The Acetabulum

Background:Posterior wall fracture of the acetabulum(PWFA)presents the most common type of acetabular fracture.It is often caused by high-energy injuries such as traffic accidents and high altitude falls.About 70%of the posterior wall fractures are comminuted and complex.At present,there are many internal fixation methods for surgical treatment of comminuted fractures of the posterior wall.It is still in controversy among domestic and foreign scholars on the type of internal fixation used for treatment.Objective:Through the retrospective study of 70 comminuted fractures of the acetabular posterior wall,which was treated surgically,we evaluate the effects of using the spike plate combined with reconstruction plate and using reconstruction plate alone in the treatment of comminuted fractures of the posterior wall of the acetabulum.Methods:A retrospective study of 70 patients with comminuted posterior wall fractures of the acetabulum surgically treated between June 2013 and March 2017 in the First Affiliated Hospital of Kunming Medical University was performed.Patients were grouped according to different internal fixation methods.A group of 33 patients were treated with reconstruction plates alone for internal fixation,and another group of 37 patients were treated with spike plate combined with reconstruction plate for internal fixation.The data collected from both groups included basic information,the injured side,the causes of injury,the comorbid injury,the preoperative sciatic nerve was damaged or not,hip joint dislocation was incorporated or not,and the time from injury to surgery,and then compare with each other.At the same time,the operation time,blood loss,duration of hospitalization,surgical complications should be collected and comparied.Postoperative efficacy was assessed according to the postoperative Matta X-ray criteria.In the final follow-up,the radiological outcomes were evaluated according to the Matta radiographic criteria and the clinical outcomes of the hip joints were evaluated according to the modified Merle d’Aubigne-Postel score.Results:After analyzing the data obtained from the two groups,we can get the following result.There was no significant difference in the results of age,gender,injured side,cause of injury,combined injury,the preoperative sciatic nerve was damaged or not,hip joint dislocation was incorporated or not,the time from injury to operation between the spike plate group and the group of reconstruction plate.It was no significant difference in the results of operation time,intraoperative blood loss and postoperative hospital stay between the two groups.There was a statistically significant difference in the incidence of late complications-traumatic osteoarthritis(TOA)(χ2 test,P<0.05).According to the post-operative X-ray Matta criterion,the reduction quality of fractures in the reconstructive plate group was considered to be excellent in 26 cases(78.8%),good in 5 cases(15.2%),poor in 2 cases(6.1%),and in the spike plate group was excellent in 30 cases(81.1%),good in 6 cases(16.2%),and poor in 1 case(2.7%).There was no significant difference between the two groups.At the last follow-up,hip imaging was rated according to Matta’s criteria.18 cases(54.6%)were excellent in the reconstructive plate group,8 cases(24.2%)were good,4 cases(12.1%)were fair,and 3 cases(9.1%)were poor.The spike plate group was excellent in 29 cases(78.4%),good in 4 cases(10.8%),fair in 3 cases(8.1%),and poor in 1 case(2.7%).The radiological rating results between them have obvious significance(z test,P<0.05).According to the modified Merle d’Aubigne-Postel score,the reconstructed plate group was excellent in 16 cases(48.5%),good in 7 cases(21.2%),fair in 4 cases(12.1%),and poor in 6 cases(18.2%);in the spike plate group,the results were excellent in 27 cases(73.0%),good in 4 cases(10.8%),fair in 4 cases(10.8%),and poor in 2 cases(5.4%).There was a statistically significant difference between the two groups(z test,P<0.05).Conclusion:The retrospective study we performed showed that spike plate combined with reconstruction plate has certain clinical value in the treatment of the comminuted posterior wall fracture of the acetabulum.Compared with the use of reconstruction plate fixation alone,the spike plate combined with the reconstruction plate can better utilize the mechanics of the anatomical structure of the acetabulum,provide a good reduction and fixation for the comminuted fracture of the posterior wall of the acetabulum,and facilitate the early functional exercise of the patient,leading to good function,It is worthy of clinical promotion.