Rocca G, Spina M, Mazzi M
Divisione di Ortopedia e Traumatologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
Divisione di Ortopedia e Traumatologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
Injury. 2014 Dec;45 Suppl 6:S9-S15. doi: 10.1016/j.injury.2014.10.016. Epub 2014 Oct 30.
We present our experience of using the Anterior Combined Endopelvic (ACE) approach, which consists of a combination of a newly modified Stoppa approach with the lateral approach to the iliac crest. This approach is discussed in terms of fracture reduction and fixation, technical aspects, and the incidence of complications, and as an alternative to the ilioinguinal approach for the treatment of acetabular fractures.
A consecutive group of 34 adult patients with acetabular fractures treated surgically with the ACE approach was compared with a group of 42 adult patients treated with the ilioinguinal approach between 2010 and 2013. Both approaches were performed by a single surgeon to fix the acetabular fractures with main anterior displacement and the anterior and lateral parts of the pelvis. All the patients were analysed with typical X-ray projections for acetabular fractures and CT-scan. Charts and radiographs were reviewed for fracture pattern. Operative time, blood loss, quality of reduction, functional outcomes and perioperative complications were compared between the two groups of patients.
The mean follow-up of patients was 26 months (range 6-49 months), with a median of 24.5 months. The types of acetabular fraction in the study were as follows: 32 anterior and posterior columns, 18 anterior columns, 10 anterior columns with posterior hemitransverse, 10 transverse associated with posterior walls, two transverse; two T-Type transverse and two anterior walls. Average blood loss was 1090 mL in the ACE group and 1200 mL in the ilioinguinal group. Anatomic or satisfactory reduction was achieved in 94% of the acetabular fractures. Two patients (one in each group) had mild symptoms of the lateral femoral cutaneous nerve and improved within 4-6 months; one patient in the ilioinguinal group developed ossification Brooks grade III.
The ACE approach for the treatment of acetabular fractures is highly recommended when the fracture involves the quadrilateral surface and anterior column. This approach provides a direct good-to-excellent visualisation and access to the entire fracture, which makes reduction and fixation easier. The clinical outcomes were slightly better with ACE compared with the ilioinguinal approach. Complication rate was similar in the two groups. The ACE technique is a viable alternative to the ilioinguinal approach when exposure of the anterior acetabulum is required.
我们介绍使用前联合盆腔内（ACE）入路的经验，该入路由新改良的Stoppa入路与髂嵴外侧入路相结合组成。从骨折复位与固定、技术要点、并发症发生率等方面对该入路进行讨论，并将其作为治疗髋臼骨折的髂腹股沟入路的替代方法。
将2010年至2013年间连续34例采用ACE入路手术治疗的髋臼骨折成年患者与42例采用髂腹股沟入路治疗的成年患者进行比较。两种入路均由同一位外科医生实施，以固定主要向前移位的髋臼骨折以及骨盆的前部和侧部。所有患者均通过髋臼骨折的典型X线投照和CT扫描进行分析。回顾图表和X线片以确定骨折类型。比较两组患者的手术时间、失血量、复位质量、功能结果和围手术期并发症。
患者的平均随访时间为26个月（范围6 - 49个月），中位数为24.5个月。研究中的髋臼骨折类型如下：32例前后柱骨折，18例前柱骨折，10例前柱伴后半横行骨折，10例横行伴后壁骨折，2例横行骨折；2例T型横行骨折和2例前壁骨折。ACE组平均失血量为1090 mL，髂腹股沟组为1200 mL。94%的髋臼骨折实现了解剖复位或满意复位。2例患者（每组各1例）出现股外侧皮神经轻度症状，并在4 - 6个月内好转；髂腹股沟组1例患者发生布鲁克斯III级骨化。
当骨折累及四边形面和前柱时，强烈推荐采用ACE入路治疗髋臼骨折。该入路能提供直接且良好至极佳的视野，便于显露整个骨折部位，使复位和固定更加容易。与髂腹股沟入路相比，ACE入路的临床结果略优。两组并发症发生率相似。当需要显露髋臼前部时，ACE技术是髂腹股沟入路的可行替代方法。
