後方寛骨臼壁骨折に対する腸骨移植片を用いた後方壁再建術

Reconstruction of acetabular posterior wall fractures is challenging. This study evaluates the use of iliac crest graft to reconstruct the posterior wall of the acetabulum.

The study population included all patients with high-grade acetabular posterior wall fractures who were treated with acetabular posterior wall reconstruction using iliac strut graft. In this study, patients with high-grade acetabular posterior wall fracture (based on Letournel and Judet's classification of acetabular fracture equivalent to grade 2 or 3 and based on AO type A1 classification) were treated with acetabular posterior wall reconstruction using iliac strut patients over 70 years old and under 18 years old were excluded from the study.

In this study, 14 patients, 10 men and 4 women, with posterior acetabular wall fractures were treated using the acetabular posterior wall reconstruction method using iliac strut graft. The average age of these patients was 60 years. One patient had evidence of avascular necrosis after 6 months. In all 8 patients, the radiological results showed that the femoral head did not completely match the acetabulum after the operation. The condition of the 48-year-old patient was good to excellent. Three patients under 50 years of age without post-traumatic osteoarthritis at the time of reconstruction had good clinical results and good radiological results. Patients with post-traumatic osteoarthritis at the time of reconstruction had poor clinical and radiological results and sometimes required THA.

The results of this study show that reconstruction of the posterior wall of the acetabulum with iliac crest graft is a suitable option for children or adult patients without post-traumatic osteoarthritis at the time of reconstruction. Mid-term follow-up showed good to excellent clinical results. However, this method is not recommended for adult patients with post-traumatic osteoarthritis during reconstruction. Such patients are likely to require THA.