Anterior-posterior approach internal fixation and reduction for complex acetabular fractures / 中华创伤杂志

ABSTRACT

Objective To evaluate the curative effect of ilio-inguinal and Kocher-Langenbeck (K-L) approach internal fixation and reduction in the treatment of acetabular fractures in a floppy lateral position.Methods A retrospective study was done on 31 patients treated from February 2005 to March 2009,including 15 patients with complex acetabular fractures treated with ilio-inguinal and K-L approach internal fixation and reduction in a floppy lateral position ( Group A) and 16 patients with complex acetabular fractures treated with anterior ilio-inguinal approach and posterior K-L approach internal fixation and successive reduction in a floppy lateral position Group B).Operation time,intra-operative blood loss,number of X-ray fluoroscopy times,degree of postoperative reduction,results of Merled' Aubigne and Postel scores as well as the rate of postoperative complications were recorded.Results All the patients were followed up for 15-27 months.In Groups A and B,the operation time was for ( 176 ± 17 ) minutes and ( 196 ± 23 ) minutes ( P ＜ 0.05 ),the intra-operative blood loss for ( 880 ± 16) ml and (874 ± 19) ml (P＞0.05),the number of X-ray fluoroscopy times for 6 ±2 and 14 ±6 respectively ( P ＜ 0.05 ).According to Mata analysis standard,the postoperative fracture reduction was anatomical in 11 patients (73％),good in three and poor in one in Group A; while the postoperative fracture reduction was anatomic in nine patients 56％ ),good in five and poor in two in Group B.The rate of anatomical reduction between the two groups had statistical difference (t =2.731,P ＜ 0.05 ).The modified Merled' Aubigne and Postel score system showed excellence rate of joint function of 93％ ( 14/15 ) in Group A and 75％ (12/16) in Group B,with statistical difference ( x2 =15.292,P ＜ 0.05).There was no statistical difference in the aspect of postoperative complications between the two groups,such as heterotopic ossification,traumatic arthritis,avascular necrosis of the femoral head,nerve injury and so on.Conclusions In a floppy lateral position,combined ilio-inguinal and K-L approach internal fixation and reduction takes advantages of sufficient exposure,good reduction,strong fixation,short operation time and few complications in the treatment of certain complex acetabular fractures,while its long-term effects are worthy of further clinical researches.