Kumar Dharmendra, Raghuwanshi Pranav, Sriwastava Ankit, Mohan Ravindra, Singh Arpit, Kumar Ashish
Department of Orthopaedic Surgery, King George's Medical University, Shah Mina Rd, Chowk, Lucknow, Uttar Pradesh, 226003, India.
J Clin Orthop Trauma. 2025 Apr 23;65:103029. doi: 10.1016/j.jcot.2025.103029. eCollection 2025 Jun.
Posterior wall acetabular fractures with marginal impaction pose significant challenges, mainly because of the risk of joint incongruity and the potential for developing post-traumatic arthritis. Restoration of the articular surface and stability are essential to achieve good outcomes. This study investigates the surgical outcomes of posterior wall acetabular fractures with marginal impaction using the Kocher-Langenbeck (KL) approach, buttress plating, and greater trochanter autografting.
This prospective cohort study was conducted on 19 patients aged 18-60 years who were treated at a tertiary care center in North India. Fractures were confirmed by radiographic imaging and CT scans. The surgical procedure included articular dis-impaction, void filling with autografts, and fixation with anatomical reconstruction using plates and screws with mean Follow-up period was (mean ± SD) 1.86 ± 0.77 (Ranges:1-3 Years) The outcome was measured using Matta's criteria for radiological evaluation, and functional outcome using the Modified Merle d'Aubigné and Postel Score. Complications were noted, including infection, avascular necrosis (AVN), myositis ossificans, and secondary surgeries.
The mean age was 37.58 ± 9.08 years, with a male predominance of 89.5 %. The most common cause was road traffic accidents, at 94.7 %. The most common fracture pattern noted was transverse with posterior wall fracture, with marginal impaction at 47.36 %, followed by isolated posterior wall fractures with marginal impaction at 42.10 %. Anatomical reduction was achieved in 73.7 % of cases, and the radiological outcomes at one year were excellent or good in 78.9 % of cases. Functional scores were excellent or good in 73.65 %. Complications included avascular necrosis with arthritis (21.1 %), myositis ossificans (10.5 %), infection (5.3 %), and conversion to total hip replacement in 10.5 % of cases.
Correction of impaction injuries with subchondral autografting and buttress plating via the KL approach provides satisfactory radiologic and functional results. However, associated injuries, particularly head injuries, are associated with poorer recovery outcomes.
伴有边缘性嵌插的髋臼后壁骨折带来了重大挑战，主要是因为存在关节不匹配的风险以及创伤后关节炎的发生可能性。恢复关节面和稳定性对于取得良好预后至关重要。本研究调查了采用Kocher-Langenbeck（KL）入路、支撑钢板固定和大转子自体骨移植治疗伴有边缘性嵌插的髋臼后壁骨折的手术效果。
这项前瞻性队列研究对19例年龄在18至60岁之间、在印度北部一家三级医疗中心接受治疗的患者进行。通过影像学检查和CT扫描确诊骨折。手术过程包括关节复位、自体骨填充骨缺损以及使用钢板和螺钉进行解剖重建固定。平均随访期为（均值±标准差）1.86±0.77（范围：1至3年）。使用Matta标准进行放射学评估，使用改良的Merle d'Aubigné和Postel评分评估功能结果。记录并发症，包括感染、缺血性坏死（AVN）、骨化性肌炎和二次手术情况。
平均年龄为37.58±9.08岁，男性占比89.5%。最常见的病因是道路交通事故，占94.7%。最常见的骨折类型是横行伴后壁骨折，伴有边缘性嵌插的占47.36%，其次是孤立的伴有边缘性嵌插的后壁骨折，占42.10%。73.7%的病例实现了解剖复位，78.9%的病例在一年时的放射学结果为优或良。73.65%的病例功能评分优或良。并发症包括伴有关节炎的缺血性坏死（21.1%）、骨化性肌炎（10.5%）、感染（5.3%），10.5%的病例转为全髋关节置换。
通过KL入路采用软骨下自体骨移植和支撑钢板固定矫正嵌插损伤可提供满意的放射学和功能结果。然而，相关损伤，尤其是头部损伤，与较差的恢复结果相关。
