Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China.
Orthop Surg. 2022 Mar;14(3):513-521. doi: 10.1111/os.13215. Epub 2022 Jan 30.
The treatment methods for posterior wall (PW) in both-column acetabular fractures are controversial. The purpose of this study was to compare reduction quality, clinical outcomes, and complications of nonfixation for posterior wall fragment and plating via the Kocher-Langenbeck (KL) approach after anterior surgical procedures in both-column acetabular fractures.
Forty-nine patients with both-column acetabular fractures associated with PW fixed via iliac fossa and Stoppa approaches from October 2012 to October 2017 were recruited into this study and were divided into two groups: Nonfix group (nonfixation for PW) and KL group (PW plating through the KL approach). Operation duration, intraoperative blood loss, reduction quality, fracture healing, and relevant complications of patients were reviewed. Merle d'Aubigné scores were used for assessing functional outcome.
The mean blood loss and operation durations were lower in Nonfix group than in KL group (both p < 0.05). The mean hospital stay durations were (18.54 ± 6.42) days and (21.17 ± 7.32) days in groups Nonfix and KL, respectively (p = 0.186). All fractures healed well with no significant difference in union time between the two groups (p = 0.210). The rates of satisfactory reduction were 84.62% (22/26) in Nonfix group and 86.96% (20/23) in KL group (p = 1.000). The mean Merle d'Aubigné scores were 15.62 ± 2.28 in Nonfix group and 16.17 ± 2.19 in KL group (p = 0.388). The complication rates were 7.69% (2/26) in Nonfix group and 34.78% (8/23) in KL group (p = 0.046).
For both-column acetabular fractures associated with PW fragment, although fixation of PW was not performed after anterior surgical procedures, satisfactory outcomes could also be obtained. However, nonfixation was a less invasive choice with a lower complication rate.
对于双柱髋臼骨折的后壁（PW），治疗方法存在争议。本研究的目的是比较经髂腹股沟和Stoppa 入路固定 PW 后，在前路手术治疗双柱髋臼骨折后，通过 Kocher-Langenbeck（KL）入路行 PW 钢板固定与非固定的复位质量、临床结果和并发症。
2012 年 10 月至 2017 年 10 月，共纳入 49 例 PW 采用髂腹股沟和 Stoppa 入路固定的双柱髋臼骨折患者，分为非固定组（不固定 PW）和 KL 组（PW 通过 KL 入路钢板固定）。回顾患者的手术时间、术中失血量、复位质量、骨折愈合和相关并发症。采用 Merle d'Aubigné 评分评估功能结果。
非固定组的平均失血量和手术时间均低于 KL 组（均 p<0.05）。非固定组和 KL 组的平均住院时间分别为（18.54±6.42）天和（21.17±7.32）天（p=0.186）。两组骨折均愈合良好，愈合时间无显著差异（p=0.210）。非固定组的满意复位率为 84.62%（22/26），KL 组为 86.96%（20/23）（p=1.000）。非固定组的 Merle d'Aubigné 评分平均为 15.62±2.28，KL 组为 16.17±2.19（p=0.388）。非固定组的并发症发生率为 7.69%（2/26），KL 组为 34.78%（8/23）（p=0.046）。
对于 PW 骨折的双柱髋臼骨折，即使在前路手术后不固定 PW，也能获得满意的结果。然而，非固定是一种侵袭性较小、并发症发生率较低的选择。
