Surgical treatment of both-column acetabular fractures through combined approaches / 中华骨科杂志

ABSTRACT

Objective To summarize the surgical techniques and results of b oth-column acetabular fracture through combination of ilioinguinal and Kocher-La ngenbeck approaches. Methods Between March 1990 and July 2001, 66 patients affec ted by both-column acetabular fractures were treated surgically through the comb ination of ilioinguinal and Kocher-Langenbeck approaches. There were 39 males an d 27 females with an average age of 37 years (range, 19 to 56 years). According to Letournel classification, all patients were diagnosed as the both-column frac tures of acetabulum. Of 66 patients, 14 were associated with dislocation or subd islocation of femoral head, 8 with dislocation of ipsilateral sacro-iliac joint, and 8 with intra-articular fragments. The interval from injury to operation was within 2 weeks in 24 and more than 2 weeks in 42. The surgical indications were as follows 1) dislocation of both column fractures over 3 mm; 2) anterior colu mn fracture associated with severe posterior column comminuted fracture or poste rior wall fracture; 3)injury lasting more than 2 weeks; 4) injury associated wit h femoral head dislocation; 5) injury associated with intra-articular fracture f ragment. Postoperative reduction quality and long-term radiographic results were evaluated according to the Matta and the Epstein criterion separately; the d’A ubigne rating scale was used for the functional results. Results The average ope rative time was 4 hours, the average blood loss was 1 400 ml. Anatomic reduction were obtained in 57 cases (86%), satisfactory reduction in 6 (9%) and unsatisfa ctory in 3 (5%). The follow-up were from 2 to 13 years with an average of 6 year s. The clinical results were 89% excellent and good, 6% fair and 5% poor respect ively; the roentgenographic results were 82% excellent, 10% fair and 8% poor res pectively. 5 cases(8%) with Grade Ⅲ heterotopic ossification were found in Ko cher-Langenbeck approach, and no heterotopic ossification was in ilioinguinal ap proach. There was 1 deep infection (1.5%) in the ilioinguinal approach, and no i nfection in the Kocher-Langenbeck approach. Conclusion The results achieved thro ugh the combined approaches were significantly better than that of the both-colu mn acetabular fractures using the extended iliofemoral approach. The combined ap proach is an ideal method for the operation of the both-column acetabular fractu res with an excellent exposure, satisfactory reduction, shorter operating time, less blood loss, and lower operative complication rate.