Stöckle U, Hoffmann R, Südkamp N P, Reindl R, Haas N P
Department of Trauma and Reconstructive Surgery Charité, Humboldt University, Berlin Germany.
J Orthop Trauma. 2002 Apr;16(4):220-30. doi: 10.1097/00005131-200204000-00002.
To assess the rate of anatomic reconstructions as well as approach-related morbidity and complications in the treatment of complex acetabular fractures through a modified extended iliofemoral approach.
Prospective clinical study.
Level I trauma center, University Hospital.
Inclusion criteria were as follows: (a) associated acetabular fracture or transverse fracture with comminuted roof area stated as not sufficiently reconstructable through a single approach, and (b) age between sixteen and sixty-five years. A total of forty-nine patients with fifty complex acetabular fractures could be included out of the series of ninety-six acetabular fractures treated operatively from August 1992 to February 1996. Open reduction and internal fixation of complex acetabular fractures through the modified extended iliofemoral approach were performed.
In 80 percent of the fifty fractures the reduction was anatomic with a remaining displacement of less than or equal to one millimeter, in eight cases there was a persistent displacement of two millimeters, and two fractures had a poor result with a three-millimeter displacement. Complications included 8 percent loss of reduction, 13 percent heterotopic ossification grade 3, and 4 percent avascular femoral head necrosis. At the two-year follow-up there were 74 percent good or excellent radiographic and clinical results. Two patients had already been reoperated with total hip replacement, and the two patients with femoral head necrosis are currently scheduled for arthroplasty.
The modified extended iliofemoral approach proved to be appropriate to achieve anatomic reduction in complex acetabular fractures. The high rate of approach-related morbidity has to be considered carefully and may lead to a decreased incidence of extended approaches.
通过改良扩大髂股入路评估复杂髋臼骨折治疗中解剖复位率以及与入路相关的发病率和并发症。
前瞻性临床研究。
大学医院一级创伤中心。
纳入标准如下：（a）伴有髋臼骨折或横形骨折且粉碎性髋臼顶区域经单一入路无法充分重建，（b）年龄在16至65岁之间。在1992年8月至1996年2月接受手术治疗的96例髋臼骨折病例系列中，共有49例患者的50例复杂髋臼骨折符合纳入标准。采用改良扩大髂股入路对复杂髋臼骨折进行切开复位内固定。
50例骨折中80%实现了解剖复位，残余移位小于或等于1毫米；8例存在2毫米的持续移位；2例骨折复位效果差，移位3毫米。并发症包括8%的复位丢失、13%的3级异位骨化和4%的股骨头缺血性坏死。在两年随访时，影像学和临床结果为优或良的比例为74%。2例患者已接受全髋关节置换再次手术，2例股骨头坏死患者目前计划进行关节成形术。
改良扩大髂股入路被证明适用于复杂髋臼骨折的解剖复位。必须认真考虑与入路相关的高发病率，这可能导致扩大入路的发生率降低。
