Operative treatment of bi-column acetabular fractures / 中华创伤骨科杂志

ABSTRACT

Objective To probe into the operative techniques and clinical outcomes of treating bi-columnar acetabular fractures. Methods From April 2001 to December 2006, 609 cases undergoing operation for aeetabular fractures were followed up. Of them, 193 eases, 147 males and 46 females with an average age of 34.4 years, were of bi-columnar type. Their complications involved the articular cartilage of the femoral head in 37, eranioeerebral trauma in 31, injury to bladder and/or urethra in 27, injury to thorax and/or abdomen in 68, injury to pelvis and/or sacroiliac joint in 59, and injury to sciatic nerve in 11. The interval between injury and surgery was within 1 week in 15 cases, within 2 weeks in 121, within 3 weeks in 34, and beyond 3 weeks in 23. A single ilioinguinal approach was adopted for 4 cases and combined ap-proaches for 189. Results The mean operating time was 238 (150 to 330) minutes, and the blood loss averaged 1453 (450 to 4400) mL. The mean follow-up period was 44.2 (14 to 84) months. All the eases were evaluated by Matta reduction criteria, X-ray manifestations and the modified Merle d'Aubingne and Postel clinical scoring. One hundred and sixty-eight patients got anatomical reduction, 17 unsatisfactory reduction, and 8 poor reduction. The X-ray manifestations were excellent in 162 patients, good in 16, fair in 8, and poor in 7. The clinic results were excellent in 152 patients, good in 27, fair in 9, and poor in 5. The Kendall coefficient correlation between reduction and clinical outcome and that between reduction and X-ray manifes-tation were 0.74 and 0.77, respectively. Ectopic ossification happened in 77 eases and transient post-operative sciatic nerve paralysis occurred in 3. Conclusions The combined approaches facilitate exposure and synergetie reduction of the bi-colunmar fractures of acetabulum. Reduction of the acetabular roof is essential to restoration of the normal contour of the acetabulum. Reduction bears a positive correlation to the clinical results as well as experience of surgeons.