Hazra Sunit, Saha Nabarun, Mallick Sunny K, Saraf Amit, Kumar Sanjay, Ghosh Sandip, Chandra Mainak
R G Kar Medical College, Kolkata, India.
Murshidabad Medical College, Berhampore, India.
Bone Jt Open. 2024 Feb 19;5(2):147-153. doi: 10.1302/2633-1462.52.BJO-2023-0161.
Posterior column plating through the single anterior approach reduces the morbidity in acetabular fractures that require stabilization of both the columns. The aim of this study is to assess the effectiveness of posterior column plating through the anterior intrapelvic approach (AIP) in the management of acetabular fractures.
We retrospectively reviewed the data from R G Kar Medical College, Kolkata, India, from June 2018 to April 2023. Overall, there were 34 acetabulum fractures involving both columns managed by medial buttress plating of posterior column. The posterior column of the acetabular fracture was fixed through the AIP approach with buttress plate on medial surface of posterior column. Mean follow-up was 25 months (13 to 58). Accuracy of reduction and effectiveness of this technique were measured by assessing the Merle d'Aubigné score and Matta's radiological grading at one year and at latest follow-up.
Immediate postoperative radiological Matta's reduction accuracy showed anatomical reduction (0 to 1 mm) in 23 cases (67.6%), satisfactory (2 to 3 mm) in nine (26.4%), and unsatisfactory (> 3 mm) in two (6%). Merle d'Aubigné score at the end of one year was calculated to be excellent in 18 cases (52.9%), good in 11 (32.3%), fair in three (8.8%), and poor in two (5.9%). Matta's radiological grading at the end of one year was calculated to be excellent in 16 cases (47%), good in nine (26.4%), six in fair (17.6%), and three in poor (8.8%). Merle d'Aubigné score at latest follow-up deteriorated by one point in some cases, but the grading remained the same; Matta's radiological grading at latest follow-up also remained unchanged.
Stabilization of posterior column through AIP by medial surface plate along the sciatic notch gives good stability to posterior column, and at the same time can avoid morbidity of the additional lateral window.
经单一前路进行后柱钢板固定可降低需要双柱稳定的髋臼骨折的发病率。本研究的目的是评估经前路骨盆内入路（AIP）进行后柱钢板固定在髋臼骨折治疗中的有效性。
我们回顾性分析了印度加尔各答R G Kar医学院2018年6月至2023年4月的数据。共有34例涉及双柱的髋臼骨折采用后柱内侧支撑钢板固定治疗。髋臼骨折的后柱通过AIP入路，在后柱内侧面用支撑钢板固定。平均随访时间为25个月（13至58个月）。通过在1年及最后一次随访时评估Merle d'Aubigné评分和Matta放射学分级来测量复位的准确性和该技术的有效性。
术后即刻放射学Matta复位准确性显示，23例（67.6%）达到解剖复位（0至1毫米），9例（26.4%）为满意复位（2至3毫米），2例（6%）为不满意复位（>3毫米）。1年末的Merle d'Aubigné评分计算显示，18例（52.9%）为优，11例（32.3%）为良，3例（8.8%）为可，2例（5.9%）为差。1年末的Matta放射学分级计算显示，16例（47%）为优，9例（26.4%）为良，6例（17.6%）为可，3例（8.8%）为差。在最后一次随访时，部分病例的Merle d'Aubigné评分下降了1分，但分级不变；最后一次随访时Matta放射学分级也保持不变。
沿坐骨切迹在内侧面用钢板经AIP对后柱进行稳定固定，可为后柱提供良好的稳定性，同时可避免额外外侧窗口带来的并发症。
