A single Kocher-Langenbeck approach to improve anterior column screw fixation for transverse + posterior wall acetabular fractures
10.3760/cma.j.cn115530-20240927-00390
- VernacularTitle:Kocher-Langenbeck入路改良前柱螺钉固定治疗髋臼横形伴后壁骨折的疗效分析
- Author:
Hongtao LI
1
;
Longxin AN
;
Qian WU
;
Jiazhi GAO
;
Bin YU
;
Jun LIU
;
Xuecheng SUN
Author Information
1. 潍坊市人民医院创伤骨科，潍坊 261000
- Publication Type:Journal Article
- Keywords:
Acetabulum;
Fractures, bone;
Fracture fixation, internal;
Bone nails;
Kocher-Langenbeck approach;
Improved front pillar screws
- From:
Chinese Journal of Orthopaedic Trauma
2025;27(6):536-540
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the efficacy of using a single Kocher-Langenbeck approach to improve anterior column screw fixation for the treatment of transverse + posterior wall acetabular fractures.Method:A retrospective analysis was conducted of the data of 21 patients who had been treated with a single Kocher-Langenbeck approach to improve anterior column screw fixation for transverse + posterior wall acetabular fractures at Department of Orthopaedics, Weifang People's Hospital from May 2021 to May 2023. There were 11 males and 10 females with an age of (51.3±15.5) years. The time from injury to surgery was (10.4±3.6) days. The anterior column screw fixation was improved as follows: screws were implanted 1 to 2 cm in front of the apex of the great notch of the external iliac plate of the pelvis to penetrate out at the upper branch root of the pubic ramus, with the whole screw fully located within the bony channel. Such indexes were recorded as surgical time, intraoperative blood loss, intraoperative fluoroscopy frequency for improved placement of anterior column screws, fracture healing time, incidence of complications, and fracture reduction and hip joint function at the last follow-up.Results:For this cohort, surgical time was (120.9±40.7) minutes, intraoperative blood loss (330.2±65.9) mL, and intraoperative fluoroscopy frequency for improved placement of anterior column screws (6.2±2.3) times. The 21 patients were followed up for (21.5±5.9) months. All fractures achieved bony union after (3.2±1.1) months. Incision fat liquefaction occurred in 1 patient after surgery and symptoms of sciatic nerve injury were observed in 2 patients. Follow-ups observed no such complications as loosening or breakage of internal fixators. According to the Matta scoring criteria, the quality of fracture reduction at the last follow-up was evaluated as anatomical reduction in 15 cases, as satisfactory reduction in 4 cases, as acceptable reduction in 2 cases, giving a satisfaction rate of 90.5% (19/21). According to the improved Merle d'Aubigné & Poster scoring criteria, hip function was evaluated as excellent in 16 cases, as good in 2 cases, and as fair in 3 cases, giving an excellent and good rate of 85.7% (18/21).Conclusion:It is effective to use a single Kocher-Langenbeck approach to improve anterior column screw fixation for the treatment of transverse + posterior wall acetabular fractures, showing advantages of reduced surgical time and intraoperative bleeding.
