Simple ilioinguinal approach combined with screwing for complex acetabular fractures / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the clinical efficacy of single ilioinguinal approach combined with screwing for treatment of complex acetabular fractures.Methods Twenty-six patients with complex acetabular fracture were treated by single ilioinguinal approach combined with screwing from May 2015 to April 2017 at Department of Orthopaedics,Hospital of Traditional Chinese Medicine,Xinjiang Medical University.They were 17 men and 9 women,aged from 31 to 69 years (average,54 years).By the Judet-Letournel classification,there were 9 anterior + posterior hemitransverse fractures,13 double-column fractures and 4 T-type fractures.They were treated by pilot surgical plan based on preoperative CT reconstruction,disinfection at floating position for the standby posterior approach,single ilioinguinal approach for standard reduction,followed by intraoperative fixation with lag screws,posterior column screws,or acetabular screws.Operation time,intraoperative blood loss and complications were documented.Fracture reduction was assessed postoperatively using the modified Matta system for X-rays.The function of affected hip was evaluated using Harris hip score at the last Follow-ups.Results The 26 patients were followed up for 6 to 24 months (average,11 months).Their operation time averaged 210 min and intraoperative blood loss 600 mL.The postoperative modified Matta scores showed that 14 cases obtained excellent anatomic reduction,9 good anatomic reduction,one poor anatomic reduction,and 2 articular outline reduction.Fracture union was achieved in all after an average time of 2.3 months.Their Harris hip scores at the last Follow-ups ranged from 70 to 86 points,averaging 80 points.The function of affected hip was excellent in 13 cases,good in 6,fair in 4 and poor in 3,giving an excellent to good rate of 73.1％ (19/26).Postoperatively,deep venous thrombosis of lower extremity was found in 3 patients,injury to the lateral femoral cutaneous nerve in 5,and incision complication in one.No re-displacement of the fracture occurred.Conclusion In treatment of complex acetabular fractures,single ilioinguinal approach combined with screwing can lead to a high rate of fine reduction,limited complications,a low displacement risk,and good clinical efficacy.