The lateral-rectus approach combined with preoperative simulation assisted by 3D printing for treatment of acetabular fractures in the elderly / 中华创伤骨科杂志

ABSTRACT

Objective To explore the efficacy of the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing for treatment of acetabular fractures in the elderly.Methods A total of 52 elderly patients with acetabular fracture were admitted to Department of Orthopaedics and Trauma,The Third Affiliated Hospital to Southern Medical University from January 2014 to December 2017.They were 36 males and 16 females,with an average age of 71.6 years (from 65 to 88 years).According to the Judet-Letournel classification,there were 5 anterior column fractures,6 transverse fractures,18 anterior and posterior hemi-transverse fractures,and 23 both-column fractures.For all cases a preoperative surgical simulation was implemented based on their 3D-printed acetabular models.A pre-bent reconstruction plate or a custom acetabular aliform plate was placed to fixate the fracture after reduction via the anterior lateral-rectus approach.The reduction quality,healing time,function of affected hip and complications were recorded.Results The operation time for this cohort ranged from 85 to 138 min (average,102 min);the intraoperative bleeding ranged from 280 to 750 mL(average,520 mL).Perioperatively,implant failure,wound infection or symptomatic lower extremity phlebothrombosis was observed in none of the patients.According to the Matta radiological evaluation,the postoperative reduction was rated as excellent in 40 cases,as good in 7 and as poor in 5 (an excellent and good rate of 90.4％).All cases were followed up for 6 to 18 (mean,10.6 months).All the acetabular fractures united after 8 to 20 weeks (average,12 weeks).According to the modified Merle d'Aubigne-Postal scoring at the final follow-up,the function of affected hip was categorized as excellent in 29 cases,as good in 12 and as fair in 11 (an excellent and good rate of 78.8％).Walking pain was experienced by 5 patients 6 months after operation,diagnosed by imaging examination as traumatic arthritis of the hip joint.Follow-ups observed no such complications as screw loosening or heterotopic ossification.Conclusion In the treatment of acetabular fractures in the elderly,the anterior lateral-rectus approach combined with preoperative simulation assisted by 3D printing can achieve effective reduction and fixation,decrease intraoperative hemorrhage,shorten operation time and reduce such complications as screw loosening caused by osteoporosis.