Surgical treatment of complex acetabular fractures through the lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws
10.3760/cma.j.issn.1671-7600.2019.06.006
- VernacularTitle:腹直肌外侧入路钢板结合后柱拉力螺钉固定治疗涉及后柱的髋臼骨折
- Author:
Jiaguo LIU
1
;
Feng SHANG
;
Bin LUO
;
Jian YANG
;
Wei XIONG
;
Jingsong ZHANG
;
Meng ZHAO
Author Information
1. 湖北医药学院附属太和医院创伤骨科
- Keywords:
Acetabulum;
Fractures,bone;
Fracture fixation,internal;
Bone nails;
Surgical approach
- From:
Chinese Journal of Orthopaedic Trauma
2019;21(6):490-497
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the surgical treatment of complex acetabular fractures through the lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws.Methods Between January 2014 and April 2018,29 patients were surgically treated for complex acetabular fractures at Department of Orthopaedic and Trauma,Taihe Hospital.They were 22 males and 7 females,aged from 19 to 72 years(mean,41.7 years).According to the Letournel-Judet classification,there were 4 transverse fractures,7 T-shape fractures,15 both column fractures and 3 anterior plus posterior hemitransverse fractures.In all the patients,the lateral-rectus approach was adopted;their anterior column fractures were fixated with pelvic reconstructive plate and screws and their posterior column fractures with antegrade lag screws.The operation time,intraoperative bleeding,fracture reduction,fracture union time,function of the affected hip and complications were recorded.Results The operation time ranged from 50 to 140 min,averaging 85 min;the volume of intraoperative bleeding ranged from 150 to 1,100 mL,averaging 315 mL.By the Matta criteria,the reduction was rated as excellent in 21 cases,as good in 7 and as poor in one,giving an excellent to good rate of 96.6％.The average follow-up was 16.2 months (from 6 to 30 months) for the 29 patients.Their fractures got united after an average of 11 weeks (from 7 to 13 weeks).According to the Merle d'Aubigné & Postel scoring system at the last follow-up,the function of the affected hip was excellent in 20 cases,good in 7 and fair in 2,yielding an excellent to good rate of 93.1％.There was one case of vasospasm of external iliac artery.No such complications were observed by follow-up as infection,deep venous thrombosis,heterotopic ossification,osteoarthritis or avascular necrosis of the femoral head.Conclusions The lateral-rectus approach with pelvic reconstructive plate and antegrade posterior-column lag screws is a suitable surgical treatment for complex acetabular fractures,leading to satisfactory clinical results.The lateral-rectus approach provides adequate exposure of the quadrilateral surface and facilitates insertion of the posterior column antegrade lag screws.
