Soni Ashwani, Gupta Ravi, Vashisht Saurabh, Kapoor Anil, Sen Ramesh
Department of Orthopaedics, Government Medical College and Hospital Sector - 32, Chandigarh, 160030, India.
Department of Orthopaedics Max Multi-speciality Hospital Mohali, 160062, India.
J Clin Orthop Trauma. 2020 Nov-Dec;11(6):1136-1142. doi: 10.1016/j.jcot.2020.10.012. Epub 2020 Oct 14.
Ilio-inguinal approach has been considered standard anterior approach for acetabulum fracture fixation. Different modifications of this approach have been described. This study analysed the patients treated using a Combined Anterior Pelvic (CAP) approach - minimal AIP (anterior intra-pelvic) with modified ilio-femoral along with 'anterior superior iliac spine' osteotomy. This combined approach provides wide exposure of pelvis to direct visualise the entire anterior column from sacroiliac joint to pubic symphysis, medial side of quadrilateral plate and entire iliac wing with minimal retraction of soft tissues required.
Data of patients treated from July 2014 to June 2018 for acetabulum fracture using CAP approach was retrieved from hospital record system. Inclusion criteria were - acetabulum fractures treated surgically using CAP approach. Exclusion criteria were - age less than 18 years, associated pelvis ring injury and incomplete peri-operative radiological record (pre-operative/post-operative antero-posterior, 45° obturator and 45° iliac oblique radiographs and pre-operative computed tomographic (CT) scans. 62 patients who met inclusion exclusion criteria were called in out-patient-department for final functional evaluation using Matta modified Merle d'aubigne score.
Out of 62 patients 47 patients who turned up for final functional evaluation were included in study. 19 patients had excellent, 15 had good, 2 had fair and 11 had poor results. Age less than 40 years, anterior column fracture pattern, Pre-operative fracture displacement >20 mm, fracture comminution and post-operative fracture reduction within 3 mm were the predictors of the functional outcome. When analysed using logistic regression model, post-operative fracture reduction was found to be the only significant predictor of functional outcome.
CAP approach is useful anterior approach to acetabulum. Fracture reduction is the independent predictor of functional outcome. Comparison of this approach with other anterior approaches to acetabulum can be area of further research.
髂腹股沟入路一直被视为髋臼骨折固定的标准前路入路。该入路有多种不同的改良方式。本研究分析了采用联合前路骨盆（CAP）入路治疗的患者——最小化的前路骨盆内（AIP）入路，联合改良的髂股入路及“髂前上棘”截骨术。这种联合入路能广泛暴露骨盆，可直接观察从骶髂关节至耻骨联合的整个前柱、四边形板的内侧以及整个髂骨翼，所需软组织牵开程度最小。
从医院记录系统中检索2014年7月至2018年6月期间采用CAP入路治疗髋臼骨折的患者数据。纳入标准为——采用CAP入路手术治疗的髋臼骨折。排除标准为——年龄小于18岁、合并骨盆环损伤以及围手术期放射学记录不完整（术前/术后前后位、45°闭孔位和45°髂骨斜位X线片以及术前计算机断层扫描（CT））。62例符合纳入排除标准的患者被召集至门诊，采用Matta改良Merle d'aubigne评分进行最终功能评估。
62例患者中，47例前来进行最终功能评估的患者被纳入研究。19例结果为优，15例为良，2例为可，11例为差。年龄小于40岁、前柱骨折类型、术前骨折移位>20 mm、骨折粉碎以及术后骨折复位在3 mm以内是功能结果的预测因素。采用逻辑回归模型分析时，发现术后骨折复位是功能结果的唯一显著预测因素。
CAP入路是一种治疗髋臼的有效前路入路。骨折复位是功能结果的独立预测因素。将该入路与其他髋臼前路入路进行比较可能是进一步研究的方向。
