Salameh Motasem, Hammad Mohammad, Babikir Elhadi, Ahmed Abdulaziz F, George Bivin, Alhaneedi Ghalib
Orthopedic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
Eur J Orthop Surg Traumatol. 2021 Apr;31(3):503-509. doi: 10.1007/s00590-020-02793-1. Epub 2020 Sep 28.
Open reduction and internal fixation through the Kocher-Langenbeck approach is the treatment of choice for selected acetabular fracture patterns. Patient positioning (lateral vs prone) can affect the outcome and post-operative complications.
A retrospective cohort of seventy-three adult patients' with acetabular fractures treated with open reduction and internal fixation through the Kocher-Langenbeck approach in either prone or lateral position. Primary outcome was the quality of radiographic fracture reduction; secondary outcomes included operative time, intra-operative estimated blood loss and pre-operative complications.
The demographics and fracture type were similar between the two groups. There was no difference in the quality of reduction using the Matta radiographic grading. Laterally positioned group demonstrated significant shorter surgical time and lower incidence of iatrogenic sciatic nerve injury. There was no difference in estimated blood loss, heterotopic ossification or infection.
This study showed no difference in the quality of fracture reduction, intraoperative blood loss, post-operative infection and heterotopic ossification between both groups. Hence, patients' condition, surgeon experience and preference are important factors for deciding patient positioning in the Kocher-Langenbeck approach for acetabulum fracture fixation.
通过Kocher-Langenbeck入路进行切开复位内固定是某些髋臼骨折类型的首选治疗方法。患者体位（侧卧位与俯卧位）会影响治疗结果及术后并发症。
一项回顾性队列研究，纳入73例接受Kocher-Langenbeck入路切开复位内固定治疗的髋臼骨折成年患者，手术体位为俯卧位或侧卧位。主要结局指标为影像学骨折复位质量；次要结局指标包括手术时间、术中估计失血量及术前并发症。
两组患者的人口统计学特征及骨折类型相似。采用Matta影像学分级评估，两组的复位质量无差异。侧卧位组手术时间显著缩短，医源性坐骨神经损伤发生率较低。估计失血量、异位骨化或感染方面无差异。
本研究表明，两组在骨折复位质量、术中失血量、术后感染及异位骨化方面无差异。因此，患者病情、外科医生经验及偏好是决定Kocher-Langenbeck入路治疗髋臼骨折固定时患者体位的重要因素。
