Byun Youngsoo, Cho Youngho, Kim Karam
Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea.
Clin Orthop Surg. 2018 Sep;10(3):279-285. doi: 10.4055/cios.2018.10.3.279. Epub 2018 Aug 22.
Displaced anterior column fractures have increasingly been treated surgically by the ilioinguinal approach and fixation with lag screws and a buttress plate on the pelvic brim. However, a major disadvantage of the ilioinguinal approach is possible damage to the neurovascular bundle and the lymphatic structures in the intermediate part of the approach. This study aims to present a novel surgical technique of the less invasive anterior iliac approach and compression osteosynthesis for high anterior column fractures of the acetabulum.
In this retrospective case series, 19 patients treated operatively for isolated high anterior column fractures using the less invasive anterior iliac approach and compression osteosynthesis were included. Patient demographics, the cause of injury, associated injuries, time to surgical reconstruction, and operation time were collected from the medical records. The quality of reduction was assessed by postoperative standard radiographic views and computed tomography scans and graded according to Matta's criteria. Clinical and radiographic grades were assessed according to Matta's criteria at the last follow-up.
This less invasive surgical technique was successful for reduction and fixation in all high anterior column fractures and provided sufficient stability to allow immediate mobilization of the patients after surgery. Twelve fractures were combined with the quadrilateral plate fracture and seven fractures did not involve the quadrilateral plate. According to Matta's criteria, anatomical reduction was obtained in 17 patients and imperfect reduction in two patients. Clinical results were excellent in 17 patients and good in two patients. Radiographic results were excellent in 17 patients and good in two patients. Ten patients had neurapraxia of the lateral femoral cutaneous nerve related to the approach, which was resolved completely in seven. One patient had deep vein thrombosis.
Our less invasive surgical technique of the anterior iliac approach and compression osteosynthesis is a useful addition to the existing techniques in the treatment of high anterior column fractures of the acetabulum. Despite being a limited approach and fixation, this technique provides sufficient exposure for reducing and fixing the fracture and adequate stability to allow immediate mobilization of the patient after surgery.
移位的髋臼前柱骨折越来越多地通过髂腹股沟入路进行手术治疗，并使用拉力螺钉和骨盆缘支撑钢板进行固定。然而，髂腹股沟入路的一个主要缺点是可能会损伤入路中间部分的神经血管束和淋巴结构。本研究旨在介绍一种用于髋臼高位前柱骨折的微创髂前入路及加压接骨术的新型手术技术。
在这个回顾性病例系列中，纳入了19例采用微创髂前入路及加压接骨术治疗孤立性高位前柱骨折的患者。从病历中收集患者的人口统计学资料、损伤原因、合并损伤、手术重建时间和手术时间。通过术后标准X线片和计算机断层扫描评估复位质量，并根据Matta标准进行分级。在最后一次随访时，根据Matta标准评估临床和影像学分级。
这种微创外科技术在所有高位前柱骨折的复位和固定中均取得成功，并提供了足够的稳定性，使患者术后能够立即活动。12例骨折合并四边形板骨折，7例骨折未累及四边形板。根据Matta标准，17例患者获得解剖复位，2例患者复位欠佳。17例患者临床结果优秀，2例患者良好。17例患者影像学结果优秀，2例患者良好。10例患者出现与手术入路相关的股外侧皮神经麻痹，其中7例完全恢复。1例患者发生深静脉血栓形成。
我们的微创髂前入路及加压接骨术是治疗髋臼高位前柱骨折现有技术的有益补充。尽管该技术是一种有限的入路和固定方法，但它为骨折的复位和固定提供了足够的暴露，并提供了足够的稳定性，使患者术后能够立即活动。
