Clinical effects of direct posterior approach with the fixation of percutaneous tunnel screw and plate for acetabular posterior comminuted fractures
10.3760/cma.j.cn121113-20210114-00042
- VernacularTitle:直接后方入路经皮后柱通道螺钉及钢板固定治疗髋臼后方粉碎性骨折
- Author:
Qiguang MAI
1
;
Yuhui CHEN
;
Tao LI
;
Hua WANG
;
Qiubao ZHENG
;
Xiaorui ZHAN
;
Kangshuai XU
;
Sheqiang CHEN
;
Jiacheng LI
;
Wenquan XU
;
Shicai FAN
Author Information
1. 南方医科大学第三附属医院骨科医学中心创伤骨科，广州 510630
- Keywords:
Acetabulum;
Open fracture reduction;
Fracture fixation, internal;
Minimally invasive surgical procedures
- From:
Chinese Journal of Orthopaedics
2021;41(19):1426-1433
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the surgical technique and the clinical effects of direct posterior approach (DPA) with the fixation of percutaneous tunnel screw and plate for acetabular posterior comminuted fractures.Methods:Thirty-six cases with acetabular posterior comminuted fractures treated by this technique from January 2016 to July 2020 were retrospectively analyzed in this study. There were 28 males and 8 female, aged 42.0±12.1 (range 19-64) years. According to Letournel-Judet classification, there were 28 cases of transverse associated with posterior wall fractures, 6 cases of posterior column with posterior wall fractures and 2 cases of T shape with posterior wall fractures. DPA was adopted in prone position. The anterior and posterior column fractures of the acetabulum were reduced under direct vision and then fixed with percutaneous tunnel screw. Further, the posterior wall fractures of the acetabulum were reduced and fixed with plate and screws. The operation duration, intraoperative blood loss, incision length, fracture union time, fracture reduction quality, postoperative complications and hip function were recorded.Results:The incision was 9.8±1.2 (range 8-12) cm. The operation duration was 102.9±21.4 (range 65-145) min. Intraoperative bleeding was 214.0±116.9 (range 100-640) ml. Postoperative X-ray and CT examinations showed perfect reduction. All the patients were followed up for 20.9±9.2 (range 10-38) months. The fracture healing time was 4.6±1.0 (range 3-6) months. There was no patient with damaged superior gluteal nerve and blood vessel. There were 2 cases of femoral head cystic changes without pain in walking, 1 case of postoperative infection and bacteremia who was cured at 1 month after debridement and anti-infection treatment, 1 case of sciatic nerve injury but recovered at 3 months after operation, and 1 case of heterotopic ossification at 3 months after surgery without affecting hip motion. According to the Matta's criteria, the reduction quality of the acetabular fracture was rated as excellent in 28 cases, good in 6 cases, fair in 2 cases. According to the modified Merle D'Aubigné and Postel scoring system, hip joint function was excellent in 24 cases, good in 10 cases and fair in 2 cases.Conclusion:DPA approach can directly reduce acetabular posterior comminuted fractures through a minimal incision. Combined with the technique of percutaneous tunnel screw, it displays great advantages of less trauma and with good clinical effects.
