Operative treatment of acetabular fractures via modified Kocher-Langenbeck approach / 中华创伤骨科杂志

ABSTRACT

Objective To investigate effectiveness of the modified Kocher-Langenbeck (K-L) approach for acetabular fractures.Methods A consecutive series of 58 patients with acetabular fracture were treated operatively from January 2013 to December 2016.They were divided into 2 groups according to the approaches used.In the experimental group of 30 patients (25 males and 5 females with an average age of 42.6 ± 13.8 years),the modified K-L approach was used not to dissect the external rotation short muscles and the anterior approach was also used when necessary.In the control group of 28 patients (24 males and 4 females with an average age of 45.2 ± 10.2 years),the traditional K-L approach was used and in combination with the anterior approach when necessary.The 2 groups were comnpared in terms of operation time,intraoperative blood loss,reduction,fracture union time and functional recovery of the affected hip at the last follow-up.Results The experimental group reported significantly shorter operation time (94.2 ± 32.8 min) and significantly less intraoperative bleeding (220.8 ± 96.7 mL) than the control group (135.8 ± 88.0 min and 405.5 ±95.7 mL) (P ＜ 0.05).According to the Matta's criteria for reduction,the experimental group had 24 excellent,4 good and 2 fair cases (an excellent to good rate of 93.3％) while the control group had 20 excellent,3 good and 5 fair cases (an excellent to good rate of 82.1％),showing no significant differences between the 2 groups (P ＞ 0.05).All the 58 patients obtained follow-up for 6 to 24 months (average,16 months).The fracture union time was 10.1 ± 1.9 weeks for the experimental group and 9.9 ±2.1 weeks for the control group,showing no significant differences between the 2 groups (P ＞ 0.05).According to the modified Merle d'Aubigne & Postel scoring for the functional recovery of the affected hip at the last follow-up,the experimental group had 23 excellent,5 good and 2 fair cases (an excellent to good rate of 93.3％) while the control group had 12 excellent,6 good,6 fair and 4 poor cases (an excellent to good rate of 64.2％),showing a significant difference between the 2 groups (P ＜ 0.05).Conclusion Compared with the traditional K-L approach,the modified K-L approach has advantages of small trauma,less hemorrhage and good postoperative recovery so that it can be a good choice among the posterior approaches for acetabular fractures.