Combined anterior and posterior approach revision for complex acetabular fractures
10.3760/cma.j.issn.1001-8050.2019.09.010
- VernacularTitle: 前后联合入路翻修治疗复杂髋臼骨折的疗效分析
- Author:
Xuejun AN
1
,
2
;
Baoshan XU
3
;
Xiaojian WANG
4
;
Yuming ZHANG
4
;
Baoguo CHANG
4
;
Feng CHANG
4
;
Jiefu SONG
4
;
Jie WEI
4
Author Information
1. Graduate School of Tianjin Medical University, Tianjin 300070, China
2. An Xuejun is working at the Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan 030012, China
3. Department of Orthopedics, Tianjin Hospital, Tianjin 300211, China
4. Department of Orthopedics, Shanxi Provincial People's Hospital, Taiyuan 030012, China
- Publication Type:Journal Article
- Keywords:
Acetabulum;
Fracture fixation, internal;
Reoperation
- From:
Chinese Journal of Trauma
2019;35(9):823-828
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of combined anterior and posterior approach revision on complex acetabular fractures.
Methods:A retrospective case series study was performed on the clinical data of 21 patients with complex acetabular fractures who underwent failed surgery through single approach from June 2012 to June 2017. There were 16 males and five females, averagely aged 34.6 years (range, 24-45 years). According to Letournel-Judet classification, there were seven patients with transverse+ posterior wall fracture, five patients with anterior column+ posterior semi-transverse fracture, four patients with double column fracture and five patients with "T" fracture. The first operation was performed by ilioinguinal approach in nine patients and by Kocher-Langebeck (K-L) approach in 12 patients. Revision surgery was performed using a combined anterior and posterior approach. The operation time and intraoperative blood loss were recorded, and the fracture healing was observed. The quality of fracture reduction was assessed according to Matta reduction criteria, and hip function by the modified D Aubigne and Postel score. The complications during and after operation were recorded. Heterotopic ossification was evaluated according to Brooker's criteria.
Results:The patients were followed up for 12 to 36 months, with an average of 27 months. The operation time ranged from 180 to 360 minutes, with an average of 270 minutes. Intraoperative bleeding was 1 000-3 800 ml, with an average of 2 000 ml. Fractures were healed, with the healing time ranging from 3.5 to 7 months, with an average of 5 months. According to Matta reduction criteria, there were eight patients with anatomical reduction, 12 with satisfactory reduction and one with unsatisfactory reduction. The improved D Aubigne and Postal score was (11.1±1.9)points preoperatively and (15.6±1.7)points six months after operation (P<0.05), the outcome of hip function was excellent in three patients, good in 14, fair in three, and poor in one, with the excellent and good rate of 81%. There were three patients with transient injury of sciatic nerve, one patient with traumatic arthritis and one with heterotopic ossification of Brooker II. No femoral head necrosis or deep venous thrombosis in the lower extremities was found.
Conclusion:For complex acetabular fractures, combined anterior and posterior approach revision can promote fracture reduction, fracture healing, and functional recovery, with low incidence of complications.
