ABSTRACT
Objective To compare the effectiveness of controlling blood loss in the treatment of complex acetabular fracture between temporary occlusion of abdominal aorta by interventional balloon (TOAAIB),temporary occlusion of common iliac artery by interventional balloon (TOCAIIB) and internal iliac artery ligation (IIAL).Methods Included for this study were 113 complex acetabular fractures which had been treated at Department of Orthopaedic Trauma,Shaoguang Hospital Affiliated to Southern Medical University from January 2000 through January 2017.There were 68 males and 45 females,aged from 23 to 61 years (average,42.3 years).According to the Letournel classification,all of them belonged to complex fractures,including 10 T-type,24 double-column,16 posterior column & posterior wall,46 transverse & posterior wall and 15 anterior & posterior half-transverse ones.They were all treated by open reduction and internal fixation but differed in surgical hemostasis techniques:TOAAIB was used in 37cases,TOCAIIB in 31 and IIAL in 45.Fracture reduction was evaluated by Matta criteria.Intraoperative bleeding and postoperative wound drainage,fracture union and complications related to interventions were recorded.Hip function was evaluated by Modified d'Aubigne & Postal clinical grading system after fracture healing.Results The 3 groups (TOAAIB,TOCAIIB and IIAL) were comparable because there were no significant differences in gender,age,time from injury to surgery,Letournel classification or surgical approaches between the patients in the 3 groups (P ＞ 0.05).Anatomical reduction was achieved in 91.15％ of the patients (103/113) and satisfactory reduction in 8.85％ (10/113).Intraoperative hemorrhage was 1,631.5 ±675.5 mL in the HAL group,892.6 ±217.7 mL in the TOCAIIB group and 648.0 ± 170.2 mL in the TOAAIB group,showing significant differences between the 3 groups (P ＜ 0.05).One case of femoral artery thrombosis occurred in the TOAAIB group at the end of operation but was cured by symptomatic treatment of anticoagulation.There were no interventional complications in the other 2 groups.There were no significant differences between the 3 groups in postoperative wound drainage,fracture union time,hip function score or complications (P ＞ 0.05).Conclusions In controlling intraoperative bleeding in the surgery for complex acetabular fracture,TOAAIB may be the best,followed by TOCAIIB,and IIAL may be the worst.However,choice of a proper surgical hemostasis technique should also depend on the specific intraoperative condition of a specific patient.
ABSTRACT
Objective To compare the value of abdominal aorta occlusion and internal iliac artery ligation in preventing massive bleeding during surgical treatment of complex acetabular fractures.Methods The study enrolled 67 cases of complicated acetabular fractures,of which 35 had control of hemorrhage via abdominal aorta blockage and 32 via internal iliac artery ligation.Intraoperative bleeding and postoperative drainage volumes were compared of the two operations.Results Of the two operations to control hemorrhage,abdominal aorta occlusion was significantly different from internal iliac artery ligation with regard to amount of blood loss [(648.00 ± 170.20) ml vs (231.18 ± 21.90) ml,t =1.693,P ＜ 0.05],but there was no significant difference between abdominal aorta occlusion and internal iliac artery ligation in postoperative drainage volume [(1 631.50 ± 675.50) ml vs (236.00 ±23.80) ml].Conclusion During surgical treatment of complex acetabular fractures,abdominal aorta occlusion is superior to internal iliac artery ligation in preventing bleeding and can be safe and effective for the fact that the bilateral common iliac arteries are occluded completely for a clear operation field.