Gänsslen Axel, Krettek Christian
Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Hannover, Germany.
Oper Orthop Traumatol. 2009 Sep;21(3):270-82. doi: 10.1007/s00064-009-1804-6.
Open anatomic reduction and stable internal fixation of both-column acetabular fractures by screw and plate osteosynthesis via the ilioinguinal approach.
Displaced both-column fractures of the acetabulum with incongruence of the hip joint, central femoral head displacement, unstable hip joint, and/or loss of hip joint congruence without the potential of a secondary congruence (near anatomic fragment orientation due to ligamentotaxis).
General contraindications. Displaced fracture of the posterior wall. Extension of the posterior column fracture to the apex of the greater sciatic notch.
Indirect open reduction of a both-column fracture of the acetabulum that is typically characterized by a multifragmentary anterior column fracture and a simple posterior column fragment using an ilioinguinal approach. Stepwise reduction and reconstruction of the anterior column according to the "proximal-to-distal" rule. Reduction and fixation of the posterior column fragment against the reconstructed anterior column.
Partial weight bearing for 8-12 weeks with 15 kg body weight, beginning on the 2nd postoperative day. Thereafter, pain-dependent weight bearing. Thrombosis prophylaxis.
Analysis of 27 patients treated between 1991 and 2005. A high-velocity trauma was the cause of injury in 74.1% of cases. Most patients showed an isolated injury of the acetabulum. In 55.5%, an additional central hip joint displacement was observed. A primary injury to the sciatic nerve was present in 14.8% of cases. Mean fracture gap/step was 14.3 mm. 81.5% of these fractures were anatomically reduced and stabilized; all joints were congruent. At 2-year follow-up, 14 out of 17 patients had no signs of posttraumatic osteoarthritis. Excellent and good functional results according to the Merle d'Aubigné Score were observed in eleven and five cases, respectively. One patient had a moderate functional outcome.
通过髂腹股沟入路，采用螺钉和钢板骨合成术对双柱髋臼骨折进行开放解剖复位和稳定内固定。
髋臼双柱骨折伴髋关节不匹配、股骨头中心移位、髋关节不稳定和/或髋关节失去匹配且无二次匹配可能（因韧带牵引导致接近解剖碎片方向）。
一般禁忌证。后壁移位骨折。后柱骨折延伸至坐骨大切迹顶点。
采用髂腹股沟入路对髋臼双柱骨折进行间接开放复位，其典型特征为多片段前柱骨折和简单后柱骨折块。根据“近端到远端”原则逐步复位和重建前柱。将后柱骨折块复位并固定于重建后的前柱上。
术后第2天开始部分负重8 - 12周，负重15千克体重，此后根据疼痛情况决定负重。预防血栓形成。
分析1991年至2005年间治疗的27例患者。74.1%的病例损伤原因是高速创伤。大多数患者为孤立性髋臼损伤。55.5%的患者观察到合并股骨头中心移位。14.8%的病例存在坐骨神经原发性损伤。平均骨折间隙/台阶为14.3毫米。这些骨折中81.5%实现了解剖复位和稳定；所有关节均匹配。在2年随访时，17例患者中有14例无创伤后骨关节炎迹象。根据Merle d'Aubigné评分，分别有11例和5例获得优秀和良好的功能结果。1例患者功能结果中等。
