Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
BMC Musculoskelet Disord. 2021 Feb 18;22(1):203. doi: 10.1186/s12891-021-04034-w.
The surgical treatment of acetabular fracture has adverse outcomes and high risk, and minimally invasive method is a good way to reduce complications and improve hip joint function. This study is to investigate the treatment of certain acetabular fractures primarily involving the anterior column and quadrilateral plate using a limited pararectus approach and the anatomical plates.
A consecutive cohort of 17 patients with anterior displaced acetabular fractures were managed operatively with a limited approach and the anatomical plates. Ten patients had anterior column fractures, 1 patient had anterior wall fracture, 4 patients had transverse fractures and 2 patients had anterior column with posterior hemi-transverse fractures. The inferior half of the pararectus approach was adopted to open the medial window and to access the anterior column and the quadrilateral plate. The anatomical plates were used for internal fixation. Residual displacements were assessed on the postoperative CT scans using a standardized digital method. The surgical details, hip functional outcomes, and complications were noted.
All of the patients were operated using the limited pararectus approach and the anatomical plates successfully. The mean operative time and blood loss were 90.9 min and 334.1 ml, respectively. The average postoperative residual gap and step displacement on CT were 2.9 mm and 0.7 mm, respectively. The radiological outcome was estimated according to the Matta score, ten of the cases were graded anatomical, six were graded imperfect, and one was graded poor. Follow up averaged 15 months. Functional outcomes were excellent for nine, good for six, and fair for two. It was noted that one case of peritoneal injury was repaired intraoperatively.
The limited pararectus approach with the advantages of less trauma, direct exposure to the anterior column and quadrilateral plate. The anatomical plates can fit with the surface of the acetabulum, which saves the time of remodeling plates during operation and facilitate fracture reduction. The combination approach can be a good choice for limited surgery of displaced anterior acetabular fractures especially involving the quadrilateral plate.
髋臼骨折的手术治疗存在不良后果和高风险，微创方法是减少并发症和改善髋关节功能的好方法。本研究旨在探讨采用有限的腹外斜肌旁入路和解剖钢板治疗某些主要涉及前柱和四边形板的髋臼骨折。
连续队列 17 例前移位髋臼骨折患者采用有限入路和解剖钢板进行手术治疗。10 例患者为前柱骨折，1 例为前壁骨折，4 例为横形骨折，2 例为前柱伴后半横行骨折。采用下半身腹外斜肌旁入路打开内侧窗，触及前柱和四边形板。使用解剖钢板进行内固定。使用标准化数字方法评估术后 CT 扫描的残余移位。记录手术细节、髋关节功能结果和并发症。
所有患者均成功采用有限的腹外斜肌旁入路和解剖钢板进行手术。手术时间和失血量的平均值分别为 90.9 分钟和 334.1 毫升。术后 CT 平均残余间隙和台阶移位分别为 2.9 毫米和 0.7 毫米。根据 Matta 评分评估放射学结果，10 例为解剖学分级，6 例为不完善分级，1 例为差分级。平均随访 15 个月。功能结果为优 9 例，良 6 例，可 2 例。术中发现 1 例腹膜损伤。
有限的腹外斜肌旁入路具有创伤小、直接暴露前柱和四边形板的优点。解剖钢板可与髋臼表面贴合，术中节省了钢板整形时间，便于骨折复位。联合入路可作为治疗移位的前髋臼骨折特别是涉及四边形板的有限手术的良好选择。
