Operative treatment of acetabular both-column fractures through a single ilioinguinal approach / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the clinical efficacy of a single ilioinguinal approach in the surgical treatment of both-column acetabular fractures in which the anterior column was fixated by a reconstruction plate and the posterior column fixated by lag screws.Methods Between May 2013 and August 2016,a total of 23 patients with acetabular both-column fracture were treated through a single lioinguinal approach for fixation of both acetabular columns at Department of Orthopaedics,Jiangyin Hospital Affiliated to Medical College,Southeast University.They were 11 males and 12 females,aged from 20 to 71 years (mean,47.6 years).Operation time,amount of intraoperative blood loss,postoperative fracture reduction,union time and relevant postoperative complications were recorded.At the final follow-up,the function of affected hip was evaluated by Merie d'Aubigne-Postel scoring system.Results All the patients underwent the operation successfully.The operation time ranged from 120 to 210 minutes (mean,165.4 minutes).The intraoperative blood loss ranged from 320 to 1,120 mL (mean,554.8 mL).The 23 patients were followed up for 12 to 40 months (mean,28.1 months).All the fractures united well after 2 to 5 months (mean,3.7 months).According to the Matta's criteria,anatomic reduction was achieved in 17 cases,satisfactory reduction in 5 and unsatisfactory reduction in one,giving a satisfactory reduction rate of 95.7％;by the modified Merle d'Aubigne and Postel functional scores for the affected hip,13 cases were excellent,6 good,3 fair and one poor,giving an excellent and good rate of 82.6％.The complication rate during follow-up was 8.7％ (2/23).One case suffered from palsy of the lateral femoral cutaneous nerve but the symptom was relieved one month postoperatively without any treatment.One patient developed deep venous thrombosis at a lower extremity which responded to anticoagulant therapy.Conclusion Surgical treatment of acetabular double column fractures through a single ilioinguinal approach for fixation of the anterior column with a reconstruction plate and fixation of the posterior column with lag screws can achieve excellent control of reduction and fixation,which is less traumatic but leads to satisfactory clinical effects.