Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Trauma Surgery, Orthopaedics and Hand Surgery, Wolfsburg General Hospital, Wolfsburg, Germany.
Arch Orthop Trauma Surg. 2024 Oct;144(10):4561-4568. doi: 10.1007/s00402-024-05471-7. Epub 2024 Aug 7.
Screw fixation of acetabular column fractures is a well-established alternative option to plate fixation providing comparable biomechanical strength and requiring less surgical exposure. For displaced acetabular fractures involving both columns open reduction and plate fixation of one column in combination with a column-crossing screw fixation of the opposite column via a single approach is a viable treatment option. Preoperative planning of posterior column screws (PCS) via an anterior approach is mandatory to assess the eligibility of the fracture for this technique and to plan the entry point and the screw trajectory. The intraoperative application requires fluoroscopic guidance using several views. A single view showing an extraarticular screw position is adequate to rule out hip joint penetration. The fluoroscopic assessment of cortical perforation of the posterior column requires several oblique views such as lateral oblique views, obturator oblique views and axial views of the posterior column or alternatively intraoperative CT scans. The application of PCS via an anterior approach is a technically demanding procedure, that allows for a relevant reduction of approach-related morbidity, surgical time and blood loss by using a single approach.
螺钉固定髋臼柱骨折是一种成熟的替代钢板固定的方法，具有相当的生物力学强度，且手术暴露更少。对于涉及双柱的移位髋臼骨折，通过单一入路行切开复位和一侧柱的钢板固定联合对侧柱的跨柱螺钉固定是一种可行的治疗选择。通过前入路进行后侧柱螺钉（PCS）的术前规划对于评估骨折是否适合该技术以及规划进钉点和螺钉轨迹是必需的。术中应用需要使用多种透视角度进行透视引导。单一显示关节外螺钉位置的透视角度足以排除髋关节穿透。后侧柱皮质穿透的透视评估需要几个斜位透视，如外侧斜位、闭孔斜位和后侧柱的轴向位，或者替代术中 CT 扫描。通过前入路应用 PCS 是一种技术要求较高的操作，通过单一入路可显著减少与入路相关的发病率、手术时间和失血量。
