Therapeutic efficacy of Kocher-Langenbeck approach without cutting hip spin short muscle tendons for treatment of acetabular posterior column fractures / 中华创伤杂志

ABSTRACT

Objective To investigate the feasibility and clinical effect of Kocher-Langebeck (K-L) approach without cutting the short external rotator muscles of hip for treatment of cetabular posterior column fractures.Methods A retrospective case series study was performed on 28 patients with acetabular fractures admitted from June 2015 to February 2017.There were 23 males and 5 females,averagely aged 43.6 years (range,26-71 years).According to the Letournel classification,there were 9 patients with simple fractures,14 back wall and back pillar fractures and 5 cross fractures.All patients were combined with posterior dislocation.The patients were given tibial tubercle traction after hip joint reduction in the hospital.During the surgery,K-L approach was adopted without cutting the short external rotator muscles of hip.Operation duration and intraoperative bleeding were recorded.Visual analogue score (VAS) was recorded before and after operation.The X-ray at 1 day,6 weeks,3 months and 1 year after operation were reviewed to evaluate fracture healing time.Matta criteria were used to assess the surface flatness of joint.The modified Merle d'Aubigné-Postel scoring system was applied to evaluate the function of hip joint.Intraoperative and postoperative complications were recorded.Results The operation duration was 76-120 min (mean,94 min),and the intraoperative blood loss was 120-320 ml (mean,265 ml).All patients were followed up for average 16 months (range,10-24 months).Preoperative VAS was 5-10 points [(7.5 ± 1.3) points],and 0-3 points [(0.9 ± 0.8) points] 6 months after operation (P ＜ 0.01).All fractures healed and the average healing duration was 10.1 weeks (range,6-12 weeks).According to the Matta criteria,24 patients were graded excellent and 4 good,with excellence rate of 100％.According to the modified Merle d'Aubigné-Postel grading system,clinical results were graded excellent in 23 patients,good in 5,with excellence rate of 100％.Transient sciatic nerve injury occurred in 3 patients after surgery,and the nerve function of these patients fully recovered within 3 months after operation.There were no infection,heterotopic ossification and other complications.The wound healing was good,without liquefaction or cracking.Sciatic nerve injury was found in five patients,three of whom were performed with a transient lesion and recovered within 3 months.Conclusion In the posterior pathway surgery for acetabular posterior column fractures,the K-L approach without cutting the short external rotator muscles of hip can be used to complete the internal fixation with a high rate of fracture healing,sound reduction outcome,satisfactory functional recovery and few complications.