Nikolopoulos Fotios V, Tzoras Nikolaos T
Department of Orthopaedic Surgery, General Hospital of Piraeus "Tzaneio," Zaniand Afentouli 1, Piraeus,Greece, 18536.
J Orthop Case Rep. 2019;10(1):78-81. doi: 10.13107/jocr.2019.v10.i01.1646.
Two similar pelvic fracture cases were both treated with the new anterior intrapelvic (AIP) approach (modified Stoppa approach)-the ilioinguinal modification. The traditional reconstruction plate is used in case 1 and the new special designed anatomical quadrilateral plate (the suprapectineal edition) is used in case 2. The two cases are discussed in terms of surgical difficulty, surgical time, blood loss, patient recovery, stability of the osteosynthesis.
Two similar cases according to the classification of Judet-Letournel acetabulum fractures were chosen. Case 1 is a male 55 years old, injured in a motor vehicle accident who had a pelvic fracture, especially a quadrilateral surface fracture in conjunction with high anterior column fracture. Case 2 is also a male 58 years old, who fall from height, had almost the same fracture type according to Judet-Letournel classification. The traditional reconstruction plate was used in case1 and the new anatomical suprapectineal plate system was used for internal fixation in case 2.
The application of the new suprapectineal plate system (anatomical plate) as seen in case 2 is not possible through the ilioinguinal approach only. The use of AIP is imperative for the fixation of the quadrilateral surface fracture using these anatomical plates. The combination of the AIP with the lateral window or the first two windows of ilioinguinal approach gives excellent access to the true pelvis and the ilium in the high anterior column fractures.
两例相似的骨盆骨折病例均采用新的骨盆内前路(AIP)入路(改良Stoppa入路)——髂腹股沟改良入路进行治疗。病例1使用传统重建钢板,病例2使用新的特殊设计的解剖四边形钢板(耻骨上版)。从手术难度、手术时间、失血量、患者恢复情况、骨合成稳定性等方面对这两个病例进行讨论。
根据Judet-Letournel髋臼骨折分类选择了两例相似病例。病例1为一名55岁男性,在机动车事故中受伤,患有骨盆骨折,尤其是四边形面骨折合并高位前柱骨折。病例2也是一名58岁男性,从高处坠落,根据Judet-Letournel分类,骨折类型几乎相同。病例1使用传统重建钢板,病例2使用新的解剖耻骨上钢板系统进行内固定。
如病例2所示,仅通过髂腹股沟入路无法应用新的耻骨上钢板系统(解剖钢板)。使用这些解剖钢板固定四边形面骨折必须采用AIP入路。AIP入路与髂腹股沟入路的外侧窗口或前两个窗口相结合,能很好地显露高位前柱骨折时的真骨盆和髂骨。