de Peretti F, Schlatterer B, Cambas P M, Argenson C
Service de Chirurgie Orthopédique et Traumatologique, Hôpital Saint-Roch, Nice, France.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(6):476-84.
The authors present the anatomical and functional results of the systematic use of Letournel's extensive lateral approach for internal fixation of the fractures of the acetabulum involving the two columns.
This prospective study concerns 25 patients. Mean age was 38 years. Mean follow-up was 4 years and 6 months (with extremes of 1 year and 9 years 9 months). 13 cases had a minimum of 4 years of follow-up. There were 1 transversal fracture, 9 transversal fractures associated with a posterior wall fracture, 2 anterior column fractures associated with a hemitransversal posterior fracture, 6 "T" shaped fractures, 7 fractures of the two columns. During the procedure, a trochanterotomy was carried out. Not any of the patients was irradiated postoperatively and they did not take any indomethacin. The patients were operated on 10 days after the accident, on average (with the extremes of 2 and 60 days). The average time of the procedure was 4 H 20 and 1080 cc of globular sediment were used during the intervention on average. The same surgeons participated in each operation.
The anatomical results were analysed according to Matta's criteria and the congruence study head-roof and head-acetabulum of the SOFCOT symposium in 1981. The functional results were analysed using the quotation of Merle d'Aubigné. Complications were searched systematically. The appearance of heterotopic ossifications was analysed according to Brooker.
23 patients had a satisfactory anatomical reduction and 11 patients out of 13 did not present any arthrosis after a minimum of 4 years follow-up. 12 patients had very good or good functional results. 3 patients had no heterotopic ossifications, 7 were grade I, 5 grade II, 8 grade III, and 2 grade IV. The gluteus medius was quoted 4 in 18 patients and 5 in 5 patients. There were 2 cases of deep suppuration, one of them was a patient who died 6 months later of a pancreas cancer unrecognized at the time of the accident. There were 5 aseptic osteonecroses and 3 cases of regressive paralysis of the sciatic nerve. 4 total hip prosthesis were inserted secondarily.
The Letournel extensive lateral approach was efficient to obtain an anatomical reduction but, functionally, it was only efficient in one case out of two. For the moment, the authors associate systematically a postoperative irradiation to reduce the ossifications (10 to 12 gray in 5 sessions). On the other hand, they try to obtain a more efficient reinsertion of the glutei muscles, thank to a bone fragment of the iliac crest.
The authors limit their indications of the Letournel's extensive lateral approach to the fractures of the two columns, not older than 10 days or to the comminuted ones.
作者展示了系统使用勒图尔内广泛外侧入路对累及双柱的髋臼骨折进行内固定的解剖学和功能结果。
这项前瞻性研究涉及25例患者。平均年龄为38岁。平均随访时间为4年6个月（最短1年，最长9年9个月）。13例患者至少随访了4年。有1例横行骨折，9例横行骨折合并后壁骨折，2例前柱骨折合并半横行后壁骨折，6例“T”形骨折，7例双柱骨折。手术过程中进行了转子截骨术。所有患者术后均未接受放疗，也未服用任何消炎痛。患者平均在事故发生后10天接受手术（最短2天，最长60天）。手术平均时间为4小时20分钟，术中平均使用1080毫升球形沉淀物。每次手术均由相同的外科医生参与。
根据马塔标准以及1981年SOFCOT研讨会的股骨头-髋臼顶和股骨头-髋臼一致性研究分析解剖学结果。使用梅勒·德奥布涅评分分析功能结果。系统地查找并发症。根据布鲁克分类法分析异位骨化的出现情况。
23例患者获得了满意的解剖复位，13例患者中有11例在至少4年的随访后未出现任何关节病。12例患者的功能结果为非常好或良好。3例患者没有异位骨化，7例为I级，5例为II级，8例为III级，2例为IV级。18例患者臀中肌评分为4分，5例患者评分为5分。有2例深部化脓，其中1例患者在事故发生时未被发现患有胰腺癌，6个月后死亡。有5例无菌性骨坏死和3例坐骨神经进行性麻痹。二期植入了4个全髋关节假体。
勒图尔内广泛外侧入路在获得解剖复位方面是有效的，但在功能方面，仅在二分之一的病例中有效。目前，作者系统地联合术后放疗以减少骨化（分5次给予10至12格雷）。另一方面，他们试图通过髂嵴骨块更有效地重新植入臀肌。
作者将勒图尔内广泛外侧入路的适应证限制于不超过10天的双柱骨折或粉碎性骨折。
