Department of Traumatic Orthopedics, Shandong Provincial Hospital, Shandong University, No. 324 Jingwu Weiqi Road, Jinan, 250012, Shandong, China.
Zoucheng People's Hospital, No. 59 Qianquan Road, Zoucheng, 273500, Shandong, China.
BMC Surg. 2022 May 10;22(1):165. doi: 10.1186/s12893-022-01597-w.
In clinical practice, acetabular posterior wall fracture combined with femoral head fracture is rare. However, with the increasing number of engineering and traffic accidents, such fractures, have increased significantly in recent years. This paper aims to explore the clinical efficiency of the Kocher-Langenbeck (K-L) and Smith-Petersen (S-P) combined approaches for open reduction and internal fixation (ORIF) of acetabular posterior wall fractures accompanied by femoral head fractures (Pipkin type IV fractures).
A retrospective study was conducted on 8 patients who underwent open reduction and internal fixation (ORIF) of Pipkin type IV fractures through the K-L combined with S-P approach in our hospital from January 2015 to January 2020. All 8 patients were successfully operated on without serious complications, such as important blood vessel and nerve damage, with an operation time of 143.8 ± 44.38 min and intraoperative blood loss of 225 ± 70.71 ml. Perioperative data were recorded. The Harris score was used to evaluate the clinical effect. Fracture reduction quality was evaluated according to the Matta radiological standard. The grade of ectopic ossification was evaluated by the Brooker grading method, and the stage of femoral head necrosis was evaluated by Ficat-Arlet staging.
The Harris score increased significantly from 57.38 ± 4.779 at 3 months, to 76.13 ± 3.682 at 6 months, 88.25 ± 3.495 at 12 months, and 92.13 ± 2.232 at 36 months postoperatively. After statistical analysis, compared with the previous observation time point, the data comparison differences between the groups were statistically significant. P < 0.001, P < 0.001, P < 0.05). By the time of the latest follow-up, 6 of the 8 patients had recovered to the level of pre-injury sports capacity. In contrast, the other 2 patients remained below the level of pre-injury sports capacity. In terms of imaging evaluation, the quality of fracture reduction on radiographs was graded as excellent in 6 patients and good in 2 patients according to Matta's criteria. At the last follow-up, no heterotopic ossification or femoral head necrosis was found in of all the images. In addition, the hip joint space was normal in 6 cases, mildly narrowed in 1 case, and clearly narrowed in 1 case.
The K-L combined with S-P approach provides effective exposure for the reduction and fixation of Pipkin type IV fractures and achieves satisfactory clinical outcomes.
在临床实践中，髋臼后壁骨折合并股骨头骨折较为少见。然而，随着工程和交通事故的增多，近年来此类骨折的发生率显著增加。本文旨在探讨 Kocher-Langenbeck（K-L）和 Smith-Petersen（S-P）联合入路切开复位内固定（ORIF）治疗髋臼后壁骨折伴股骨头骨折（Pipkin Ⅳ型骨折）的临床疗效。
回顾性分析 2015 年 1 月至 2020 年 1 月我院采用 K-L 联合 S-P 入路切开复位内固定治疗的 8 例 Pipkin Ⅳ型骨折患者的临床资料。所有患者均顺利完成手术，无重要血管和神经损伤等严重并发症，手术时间为 143.8±44.38min，术中出血量为 225±70.71ml。记录围手术期相关数据。采用 Harris 评分评估临床疗效，Matta 影像学标准评估骨折复位质量，Brooker 分级法评估异位骨化程度，Ficat-Arlet 分期评估股骨头坏死分期。
术后 3、6、12、36 个月时，Harris 评分分别由术前的 57.38±4.779 分显著提高至 76.13±3.682 分、88.25±3.495 分、92.13±2.232 分，与术前比较差异均有统计学意义（P<0.001，P<0.001，P<0.05）。末次随访时，6 例患者恢复至伤前运动能力水平，2 例患者运动能力低于伤前。影像学评估显示，按 Matta 标准，6 例骨折复位质量评定为优，2 例为良。末次随访时，所有患者均未见异位骨化或股骨头坏死。其中 6 例髋关节间隙正常，1 例轻度狭窄，1 例明显狭窄。
K-L 联合 S-P 入路可充分暴露髋臼后壁骨折，为骨折复位和固定提供有效途径，临床疗效满意。
