Khalifa Ahmed, Fergany Ali, Ibrahim Bahaaeldin, Farouk Osama
South Valley University, Qina, Egypt.
Assiut University Hospitals, Assiut, Egypt.
Int Orthop. 2025 Jan;49(1):249-257. doi: 10.1007/s00264-024-06383-2. Epub 2024 Nov 27.
To describe the indications, outcomes, and incidence of complications after hardware removal from anterior approaches following acetabular fractures.
Over ten years, 13 patients were included, complaining of pain due to late infection in nine (69.2%) and secondary osteoarthritis in four (30.8%). Fractures classification were T-type fracture (46.2%), both columns (38.5%), one transverse (7.7%), and one (7.7%) T-type with a posterior wall. The approaches utilized for hardware removal were modified Stoppa in 11 (84.6%) patients, ilioinguinal lateral (iliac) window in nine (69.2%), Pararectus in one (7.7%), ilioinguinal in one (7.7%), and Kocher-Langenbeck approach in one (7.7%)).
The patients' mean age was 37.1 ± 14.9 (21 to 65) years, and nine (69.2%) were males. Hardware removal was performed after the index surgery by a mean of 35.6 ± 20 months. The mean operative time was 143.8 ± 36 min, and the mean blood loss was 1573 ± 842 CC. The mean hospital stay was 3.2 ± 2.3 days, and all patients required blood transfusion. Four (30.8%) intraoperative complications, two (15.4%) vascular injuries, One (7.7%) urinary bladder injury, and in two (15.4%) broken screws could not be retrieved. Postoperative complications in five (38.5%): three (23.1%) had superficial wound infection, one (7.7%) had DVT, and one (7.7%) had L5 nerve root injury. After a mean follow up of 11.3 ± 4.4 (6 to 20) months, the VAS score decreased from a preoperative median of 6 (2 to 8) to a median score of 1 (0 to 6) at the last follow up. 11 (84.6%) patients described the pain as none or occasional, and eight (61.5%) were very satisfied with the results.
Hardware removal from the anterior approaches after acetabular fractures is demanding and carries a high complication risk. The surgeries should be performed when highly indicated, and the surgical team must be familiar with the anterior approaches.
描述髋臼骨折前路内固定物取出术后的适应证、治疗结果及并发症发生率。
在十年间纳入了13例患者，其中9例（69.2%）因晚期感染而疼痛，4例（30.8%）因继发性骨关节炎而疼痛。骨折类型为T型骨折（46.2%）、双柱骨折（38.5%）、单横形骨折（7.7%）以及1例（7.7%）合并后壁的T型骨折。11例（84.6%）患者采用改良Stoppa入路取出内固定物，9例（69.2%）采用髂腹股沟外侧（髂骨）窗入路，1例（7.7%）采用腹直肌旁入路，1例（7.7%）采用髂腹股沟入路，1例（7.7%）采用Kocher-Langenbeck入路。
患者平均年龄为37.1±14.9（21至65）岁，9例（69.2%）为男性。在内固定术后平均35.6±20个月取出内固定物。平均手术时间为143.8±36分钟，平均失血量为1573±842毫升。平均住院时间为3.2±2.3天，所有患者均需要输血。术中并发症4例（30.8%），其中血管损伤2例（15.4%），膀胱损伤1例（7.7%），2例（15.4%）断钉无法取出。术后并发症5例（38.5%）：3例（23.1%）发生浅表伤口感染，1例（7.7%）发生深静脉血栓，1例（7.7%）发生L5神经根损伤。平均随访11.3±4.4（6至20）个月后，视觉模拟评分（VAS）从术前中位数6分（2至8分）降至末次随访时的中位数1分（0至6分）。11例（84.6%）患者表示疼痛消失或偶尔出现，8例（61.5%）对结果非常满意。
髋臼骨折前路取出内固定物手术难度大，并发症风险高。手术应在严格适应证下进行，手术团队必须熟悉前路手术。
