Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, South Korea.
Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, South Korea, Seoul.
Sci Rep. 2022 Sep 8;12(1):15221. doi: 10.1038/s41598-022-19368-1.
Treatment of superomedially displaced acetabular fractures including a quadrilateral surface (QLS) is challenging. We present a surgical technique using an anatomical suprapectineal QLS plate through the modified Stoppa approach and report the availability of this plate to treat this fracture type along with the surgical outcomes. Sixteen consecutive patients (14 men and 2 women) who underwent surgical treatment using an anatomical suprapectineal QLS plate through a modified Stoppa approach for superomedially displaced acetabular fractures between June 2018 and June 2020, were enrolled retrospectively. These fractures included 11 both-column fractures and 5 anterior-column and posterior hemitransverse fractures, which were confirmed on preoperative 3-dimensional computed tomography. Surgical outcomes were clinically assessed using the Postel Merle d'Aubigné (PMA) score and visual analog scale (VAS) score at the final follow-up, and radiological evaluations were performed immediately after the operation and at the final follow-up. For comparative analysis, 23 patients who underwent internal fixation with the conventional reconstruction plate through modified ilioinguinal approach between February 2010 and May 2018, were selected. This control group was composed of 18 both-column fractures and 5 anterior-column and posterior hemitransverse fractures. The follow-up period was at least 1 year in all patients. The mean operation time and blood loss was 109 min, and 853 ml, respectively, whereas 236 min, and 1843 ml in control group. Anatomical reduction was achieved in 14 (87.5%) patients, while imperfect reduction was achieved in the remaining 2 patients. At the final follow-up, radiographic grades were excellent, fair, and poor in 14 patients (87.5%), one, and one, respectively. The mean PMA score was 16.1 (range 13-18) and the mean VAS score was 1.0 (range 0-3). No secondary reduction loss or implant loosening was observed. However, 2 patients underwent conversion to total hip arthroplasty (THA) due to post-traumatic arthritis and subsequent joint pain. No other complications were observed. In the comparative analysis, radiological outcome showed a significant relationship with the conversion to THA (p = 0.013). Shorter operation time and less blood loss were significantly observed in the QLS plate fixation group through the modified Stoppa approach compared with the conventional reconstruction plate fixation group through modified ilioinguinal approach (p < 0.001, respectively). Simultaneous reduction and fixation using an anatomical suprapectineal QLS plate through the modified Stoppa approach may be a viable technique in superomedially displaced acetabular fractures along with shorter operation time and less blood loss.
治疗包括四边形面（QLS）在内的向中上方移位的髋臼骨折具有挑战性。我们介绍了一种通过改良Stoppa 入路使用解剖型耻骨上 QLS 板的手术技术，并报告了这种钢板可用于治疗这种骨折类型以及手术结果。2018 年 6 月至 2020 年 6 月，我们回顾性纳入了 16 例连续接受改良 Stoppa 入路解剖型耻骨上 QLS 板治疗向中上方移位髋臼骨折的患者（14 例男性，2 例女性）。这些骨折包括 11 例双柱骨折和 5 例前柱和后半横形骨折，术前三维 CT 已确诊。在最终随访时，采用 Postel-Merle d'Aubigné（PMA）评分和视觉模拟评分（VAS）对手术结果进行临床评估，并在术后即刻和最终随访时进行影像学评估。为了进行对比分析，我们选择了 2010 年 2 月至 2018 年 5 月期间通过改良髂腹股沟入路使用常规重建钢板内固定的 23 例患者作为对照组，该对照组包括 18 例双柱骨折和 5 例前柱和后半横形骨折。所有患者的随访时间均至少为 1 年。QLS 板固定组的平均手术时间和出血量分别为 109 分钟和 853 毫升，而对照组分别为 236 分钟和 1843 毫升。14 例（87.5%）患者达到解剖复位，2 例（12.5%）患者复位不理想。最终随访时，14 例（87.5%）患者影像学分级为优，1 例（6.2%）为良，1 例（6.2%）为差。平均 PMA 评分为 16.1（范围 13-18），平均 VAS 评分为 1.0（范围 0-3）。未观察到继发性复位丢失或植入物松动。然而，由于创伤后关节炎和随后的关节疼痛，有 2 例患者转为全髋关节置换术（THA）。未观察到其他并发症。在对比分析中，影像学结果与转为 THA 有显著相关性（p=0.013）。与改良髂腹股沟入路常规重建钢板内固定组相比，改良 Stoppa 入路 QLS 板固定组的手术时间更短，出血量更少（p<0.001）。通过改良 Stoppa 入路同时进行解剖型耻骨上 QLS 板的复位和固定可能是治疗向中上方移位髋臼骨折的一种可行技术，手术时间更短，出血量更少。
