Wang Jun-Jie, Ni Jiang-Dong, Song De-Ye, Ding Mu-Liang, Huang Jun, He Guang-Xu, Li Wen-Zhao
Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China.
World J Clin Cases. 2020 Jun 26;8(12):2634-2640. doi: 10.12998/wjcc.v8.i12.2634.
Acetabular anterior wall fracture with preservation of the pelvic brim is extremely rare. It is different from anterior wall fracture classified by Judet and Letournel. Few studies have reported cases treated by open reduction and internal fixation the Smith-Petersen or iliofemoral approach.
We report a 48-year-old Chinese woman who had difficulty moving her right hip from abduction and external rotation after falling from 3 m. Pelvic radiograph and three-dimensional reconstruction of computed tomography revealed acetabular anterior wall fractures combined with fractures of the anterior inferior iliac spine and the iliac wing but not involving the pelvic brim. First, the patient underwent interim management by closed reduction of the hip dislocation and skin traction for 6 d. Then, we used a modified pararectus approach for treatment to fix the acetabular fractures with a reconstruction plate and nonlocking T-shape plate. At the 9-mo follow-up, the patient could walk painlessly without necrosis of the femoral head or heterotopic ossification, and the X-rays and computed tomography scan reconstructions showed good bone union.
The modified pararectus approach described here can facilitate exposure, reduction, and osteosynthesis for atypical acetabular fracture with less invasiveness.
髋臼前壁骨折伴骨盆缘完整极为罕见。它不同于Judet和Letournel分类的前壁骨折。很少有研究报道采用Smith-Petersen或髂股入路切开复位内固定治疗的病例。
我们报告一名48岁中国女性，从3米高处坠落致右髋关节外展和外旋活动困难。骨盆X线片及计算机断层扫描三维重建显示髋臼前壁骨折合并髂前下棘和髂骨翼骨折，但未累及骨盆缘。首先，患者接受髋关节脱位闭合复位及皮肤牵引6天的临时处理。然后，我们采用改良的旁直肌入路进行治疗，用重建钢板和非锁定T形钢板固定髋臼骨折。在9个月的随访中，患者可无痛行走，无股骨头坏死或异位骨化，X线片和计算机断层扫描重建显示骨折愈合良好。
本文所述改良旁直肌入路可减少侵袭性，便于显露、复位和骨固定治疗非典型髋臼骨折。
