Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2022 Jan;14(1):65-72. doi: 10.1111/os.12968. Epub 2021 Dec 5.
To evaluate the radiological and clinical outcomes of the surgical treatment for transverse and posterior wall fractures using single-column posterior fixation.
From January 2009 to January 2018, a total of 24 patients with transverse and posterior wall acetabular fractures in our center were included in this retrospective study, including 17 males and seven females with a mean age of 47 years and a minimum follow-up of 1 year. All cases were closed fractures. All fractures were fixed with single-column fixation via the Kocher-Langenbeck approach. Primary outcome measures, including quality of reduction and clinical outcomes, were recorded by an independent observer, who also noted secondary outcome measures, including time to surgery, surgical time, intraoperative blood loss, and postoperative complications.
Twenty-four patients (range, 26-74 years) included 17 males and seven females. There were 14 cases on the left side and 10 cases on the right side. The mean time from injury to surgery was 7.1 days. Mean intraoperative blood loss and surgical time were 405.4 mL and 135.8 min, respectively. The mean follow-up time was 29.5 months (range 12-96 months). All the acetabular fractures united within 5 months after surgery. The quality of reduction was graded as anatomical in 17 cases (70.8%), imperfect in three cases (12.5%), and poor in four cases (16.7%). According to grading system of Merle d' Aubigne and Postel, clinical outcomes at the final follow-up were excellent in 10 cases (41.7%), good in six cases (25.0%), fair in five cases (20.5%), and poor in three cases (12.5%). The excellent and good rate was 66.7%. There was a significant relation between the quality of reduction and clinical outcomes (P < 0.05). At follow-up, there were one case of sciatic nerve injury, one case of wound infection, two cases of deep vein thrombosis, two cases of avascular necrosis, three cases of heterotopic ossification, and five cases of postoperative traumatic arthritis. Three of these patients underwent reoperation, including one with heterotopic ossification affecting hip movement and two with femoral head necrosis.
Our study shows that single-column posterior fixation of transverse and posterior wall acetabular fracture through the Kocher-Langenbeck approach can obtain satisfactory radiological and clinical outcomes if there is adequate indirect reduction of the anterior column.
评估经 Kocher-Langenbeck 入路单柱后固定治疗横后柱髋臼骨折的影像学和临床疗效。
回顾性分析 2009 年 1 月至 2018 年 1 月我院收治的 24 例横后柱髋臼骨折患者资料，男 17 例，女 7 例；年龄 26~74 岁，平均 47 岁。所有患者均为闭合性骨折。均采用 Kocher-Langenbeck 入路行单柱固定治疗。由 1 名观察者评估复位质量和临床疗效，并记录手术时间、术中出血量、术后并发症等次要结局。
24 例患者（左侧 14 例，右侧 10 例）中男 17 例，女 7 例；年龄 2674 岁，平均 47 岁。受伤至手术时间 7.1 d。术中出血量 405.4 ml，手术时间 135.8 min。平均随访 29.5 个月（1296 个月）。所有患者骨折均愈合，愈合时间 5 个月内。根据 Matta 复位标准评定，解剖复位 17 例（70.8%），复位不良 3 例（12.5%），复位差 4 例（16.7%）。末次随访时采用 Merle d'Aubigne 和 Postel 髋关节功能评分系统评定临床疗效：优 10 例（41.7%），良 6 例（25.0%），可 5 例（20.5%），差 3 例（12.5%），优良率 66.7%。复位质量与临床疗效密切相关（P<0.05）。随访期间发生坐骨神经损伤 1 例，伤口感染 1 例，深静脉血栓形成 2 例，股骨头坏死 2 例，异位骨化 3 例，创伤性关节炎 5 例。其中 3 例行翻修手术，2 例为异位骨化导致髋关节活动受限，1 例为股骨头坏死。
经 Kocher-Langenbeck 入路单柱后固定治疗横后柱髋臼骨折，如果能充分恢复前柱的间接复位，可获得满意的影像学和临床疗效。
