Hu Tu, Xu Haitao, Jiang Chaolai, Ren Geliang, An Zhiquan
Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China (mainland).
Department of Trauma Orthopedics, Huainan Xinhua Hospital, Huainan, Anhui, China (mainland).
Med Sci Monit. 2017 Jun 7;23:2765-2774. doi: 10.12659/msm.901966.
BACKGROUND The aim of this study was to explore the surgical treatment of transverse with or without posterior wall fractures of the acetabulum. MATERIAL AND METHODS We surgically treated 21 consecutive cases of pure transverse (7 cases) and with posterior wall (14 cases) fractures of the acetabulum. The anterior column fractures were firstly reduced, temporarily fixed through a modified Smith-Petersen small incision, and finally fixed after the fixation of the posterior column and wall fractures, which were reduced and fixed through a Kocher-Langenbeck approach. The operative time, intra-operative blood loss, quality of reduction (Matta criteria), perioperative complications, osseous union, subsequent complications, and hip function evaluation were recorded. RESULTS The mean operative time was 198.1 min and the mean intra-operative blood loss was 938.1 ml. Anatomic reduction of the anterior column was obtained in 20 cases and was imperfect in 1 case. All posterior column and wall fractures were anatomically reduced. We followed up 18 cases for a mean duration of 16.3 (8-30) months. All the fractures achieved osseous union. The mean Harris score was 85.1 points, with an excellent result in 7 cases, good in 8, fair in 2, and poor in 1. According to modified Merle d' Aubigne and Postel score system, the results were excellent in 2 cases, good in 15, and poor in 1. Avascular necrosis of the femoral head occurred in 1 case, heterotopic ossification in 3 cases, and numbness of the anterolateral thigh in 6 cases. CONCLUSIONS For transverse with or without posterior wall fractures of the acetabulum, reduction and fixation of anterior and posterior column should be done in sequence, and a modified Smith-Petersen small incision might be a good choice in reduction and fixation of the anterior column because it possesses advantages of direct visualization and minimal invasion.
背景 本研究旨在探讨髋臼横行骨折伴或不伴后壁骨折的手术治疗方法。
材料与方法 我们对21例连续的单纯髋臼横行骨折（7例）和伴后壁骨折（14例）患者进行了手术治疗。先行前柱骨折复位，通过改良的Smith-Petersen小切口临时固定，待后柱及后壁骨折经Kocher-Langenbeck入路复位固定后再最终固定前柱骨折。记录手术时间、术中出血量、复位质量（Matta标准）、围手术期并发症、骨愈合情况、后续并发症以及髋关节功能评估结果。
结果 平均手术时间为198.1分钟，平均术中出血量为938.1毫升。20例前柱骨折获得解剖复位，1例复位欠佳。所有后柱及后壁骨折均获得解剖复位。我们对18例患者进行了平均16.3（8 - 30）个月的随访。所有骨折均实现骨愈合。平均Harris评分为85.1分，其中优7例，良8例，可2例，差1例。根据改良的Merle d'Aubigne和Postel评分系统，结果为优2例，良15例，差1例。发生股骨头缺血性坏死1例，异位骨化3例，大腿前外侧麻木6例。
结论 对于髋臼横行骨折伴或不伴后壁骨折，应依次进行前后柱的复位和固定，改良的Smith-Petersen小切口在复位和固定前柱时可能是一个不错的选择，因为它具有直视和微创的优点。
