Treatment of double-column acetabular fractures with open reduction and internal fixation through a single lateral rectus abdominis approach / 中华创伤杂志

ABSTRACT

Objective:To investigate the clinical effect of open reduction and internal fixation for the treatment of double-column acetabular fractures by lateral rectus abdominis approach.Methods:A retrospective case series study was conducted to analyze the data of 44 patients with double-column acetabular fractures admitted to Shandong Provincial Hospital Affiliated to Shandong First Medical University from June 2015 to June 2019. There were 29 males and 15 females, with the age of 21-72 years [(41.3±8.4)years]. All patients were treated by open reduction and internal fixation through a single lateral rectus abdominis approach. Operation time, intraoperative blood loss and fracture healing time were recorded. The quality of fracture reduction was assessed according to the Matta reduction criteria, and hip function by the modified Merle D'Aubigne and Postel score at last follow-up. Postoperative complications were observed.Results:A total of 40 patients were followed up and 4 patients were lost to follow-up. The follow-up time was 12-46 months [(30.5±6.4)months]. The operation time ranged from 45 to 150 minutes[(111.2±20.6)minutes], and the intraoperative blood loss was 200-1 200 ml [(398.5±78.5)ml]. The fractures were healed, with the healing time of 10 to 16 weeks [(11.8±3.3)weeks]. At last follow-up, according to the Matta criteria, the results were excellent in 29 patients, good in 7, fair in 3, poor in 1, with the excellent and good rate of 90%. At last follow-up, according to the Merle D'Aubigne and Postel score, the results were excellent in 27 patients, good in 6, fair in 6, poor in 1, with the excellent and good rate of 83%. One patient had heterotopic ossification with no impact on hip function, and no special treatment was given. One patient with the reaction of foreign body was finally controlled by anti-infection treatment, and the internal fixation was removed again one year after operation. Three patients with mild osteoarthritis were relieved by oral anti-inflammatory and analgesic drugs. Two patients with deep venous thrombosis of lower extremities were cured by anti-coagulation therapy such as low molecular weight heparin.Conclusions:The single rectus abdominis approach for open reduction and internal fixation of double-column acetabular fractures can take into account the anterior column, quadrilateral body and posterior column. Meanwhile, this approach has advantages of satisfactory acetabular reduction and functional recovery, and less postoperative complications, suggesting an alternative procedure for treatment of double-column acetabular fractures.