Kumar Sandeep, Gugale Shataayu, Goyal Rohit, Mishra Akash, Bhambhu Vivek, Choudhary Ganpat
Mahatma Gandhi University of Medical Sciences and Technology, Rajasthan, India.
Institute of Medical Sciences, Banaras Hindu University, India.
J Clin Orthop Trauma. 2024 Nov 23;59:102837. doi: 10.1016/j.jcot.2024.102837. eCollection 2024 Dec.
Acetabulum fractures involving both columns are complicated injuries to treat, and achieving satisfactory post operative reduction with less extensile approaches is difficult. These injuries often require dual approaches, associated with their own share of complications. The anterior intrapelvic approach (AIP) addresses both columns through a single approach, minimizing these complications. Specifically, posterior column fixation is of utmost importance. This study aims to evaluate functional outcomes and complications of posterior column fixation using medial surface buttress plate in fractures involving both columns.
Between 2017 and 2024, 366 patients had fractures involving both columns, out of which 64 were operated using the AIP approach. Excluding patients with displaced posterior wall fractures, transverse fractures, delayed treatment, or aged under 18 years. Out of 64, we collected data from 60 patients, as 4 patients could not be followed up. All patients were operated using the AIP approach, and posterior column fixation was done using 3.5 mm reconstruction plates. Patients were followed for minimum 6 months-70 months, with an average of 29 months. The associations between variables and functional outcomes were examined using the Chi-Square Test or Fisher's Exact Test.
The study included 60 patients, with 48.3 % under 40 years old and 51.7 % older. Males comprised 68.3 % of the cohort. 46.7 % sustained road traffic accidents and 53.3 % had fall from height. T-type fractures were most common (50.0 %), with high posterior column fractures in 66.7 % of patients. Post-operative reductions less than 1 mm were achieved in 80.0 % of patients. Functional outcomes using the Harris hip Scores were found to be excellent to good in 90.0 % of patients.
We conclude that medial surface buttress plating of the posterior column using the standard AIP approach can be utilised to treat even the most complex of acetabular fracture patterns involving both anterior as well as posterior columns, excluding those that contain a displaced posterior wall.
累及双柱的髋臼骨折治疗复杂，采用创伤较小的手术入路实现满意的术后复位较为困难。这些损伤通常需要联合入路，且伴有各自的并发症。骨盆内前路入路（AIP）通过单一入路处理双柱，可将这些并发症降至最低。具体而言，后柱固定至关重要。本研究旨在评估使用内侧支撑钢板对累及双柱骨折进行后柱固定的功能结果和并发症。
2017年至2024年间，366例患者发生累及双柱的骨折，其中64例采用AIP入路手术。排除后壁骨折移位、横形骨折、治疗延迟或年龄在18岁以下的患者。64例中，我们收集了60例患者的数据，因为4例患者失访。所有患者均采用AIP入路手术，后柱固定使用3.5mm重建钢板。患者随访至少6个月至70个月，平均29个月。使用卡方检验或Fisher精确检验检查变量与功能结果之间的关联。
该研究纳入60例患者，48.3%年龄在40岁以下，51.7%年龄较大。男性占队列的68.3%。46.7%的患者因道路交通事故受伤，53.3%的患者高处坠落受伤。T型骨折最常见（50.0%），66.7%的患者为高位后柱骨折。80.0%的患者术后复位小于1mm。使用Harris髋关节评分发现90.0%的患者功能结果为优至良。
我们得出结论，采用标准AIP入路对后柱进行内侧支撑钢板固定，可用于治疗即使是累及前后双柱的最复杂髋臼骨折类型，但不包括后壁移位的骨折。
