Suomalainen Piia, Honkonen Essi, Nurmi Sami, Välikoski Anu, Siiki Antti
Department of Orthopaedics and Traumatology, Tampere University Hospital, Tampere, Finland.
Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.
Adv Orthop. 2025 Mar 26;2025:2914086. doi: 10.1155/aort/2914086. eCollection 2025.
When operating on acetabular fractures in conventional open surgery, visualization of crucial structures can be challenging. In recent years there have been several case reports on laparoscopy-assisted acetabulum surgery in the literature. Therefore, we have developed this method further using extraperitoneal endoscopy to manage acetabulum fractures. Operative technique: An experienced hernia surgeon familiar with the totally extraperitoneal laparoscopic technique facilitates access to the acetabulum area so that orthopaedic surgeons can focus on fixing the area with a plate and screws through laparoscopy ports. We developed this operative technique in a cadaver laboratory where we could easily fix and plate the acetabulum area with extraperitoneal endoscopy visualization in seven cadavers both on the left and right sides. A minimally invasive full endoscopic procedure for acetabular fractures offers significant benefits over traditional open surgery due to faster rehabilitation, potentially less blood loss, and fewer wound complications. According to our initial experiences with cadavers, this minimally invasive method appears promising in terms of superior visibility and easier access to the otherwise narrow and difficult fracture site in the pelvic region compared to open surgery. Furthermore, this minimally invasive method seems feasible for exact plate placement under combined endoscopic and fluoroscopic visual control. The usefulness of this novel method in the minimally invasive treatment of acetabular fractures in real life, especially considering the practicality of proper fracture reduction, should be confirmed in future clinical trials.
在传统开放手术中对髋臼骨折进行手术时，关键结构的可视化可能具有挑战性。近年来，文献中有几例关于腹腔镜辅助髋臼手术的病例报告。因此，我们进一步开发了这种方法，采用腹膜外内镜来处理髋臼骨折。手术技术：一位熟悉完全腹膜外腹腔镜技术的经验丰富的疝外科医生有助于进入髋臼区域，以便骨科医生能够通过腹腔镜端口专注于用钢板和螺钉固定该区域。我们在尸体实验室开发了这种手术技术，在那里我们可以通过腹膜外内镜可视化，轻松地在七具尸体的左右两侧对髋臼区域进行固定和钢板置入。与传统开放手术相比，髋臼骨折的微创全内镜手术具有显著优势，因为康复更快、潜在失血量更少且伤口并发症更少。根据我们对尸体的初步经验，与开放手术相比，这种微创方法在视野优越性以及更容易进入骨盆区域原本狭窄且困难的骨折部位方面似乎很有前景。此外，这种微创方法在联合内镜和透视视觉控制下精确放置钢板似乎是可行的。这种新方法在现实生活中髋臼骨折微创治疗中的实用性，特别是考虑到正确骨折复位的可行性，应在未来的临床试验中得到证实。
