Objective: To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures.
Methods: Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days).
Results: The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d'Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred.
Conclusion: For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.
目的: 探讨改良Stoppa入路联合髂窝入路及Kocher-Langenbeck入路重建钢板内固定治疗复杂髋臼骨折的近期疗效。.
方法: 2015年1月—2020年1月，采用改良Stoppa入路联合髂窝入路及Kocher-Langenbeck入路重建钢板内固定治疗30例复杂髋臼骨折患者。其中，男20例，女10例；年龄25～71岁，平均52.1岁。致伤原因：交通事故伤17例，高处坠落伤13例。骨折累及左侧髋臼14例，右侧16例；Letournel分型：双柱骨折16例，横形伴后壁骨折2例，前柱伴后半横形骨折4例，T形骨折8例；骨折移位6～30 mm，平均11.6 mm。受伤至手术时间为6～14 d，平均8.7 d。.
结果: 手术时间2.0～4.5 h，平均3.0 h；术中出血量200～800 mL，平均450.0 mL，术中均给予自体血回输。切口均Ⅰ期愈合，无切口感染发生。患者均获随访，随访时间12～15个月，平均13.4个月。术后2～3 d拔除引流管后行骨盆X线片及三维CT复查，骨折复位根据Matta评分标准获优20例、良5例、差5例，优良率83.3%。X线片复查示髋臼骨折均愈合，愈合时间16～25周，平均17.7 周。术后1年，髋关节功能按Merle d’Aubigne-Postel评价标准，优18例、良6例、可6例，优良率80.0%。术中2例牵拉导致坐骨神经损伤，术后7例出现异位骨化、2例出现创伤性髋关节炎，无其他并发症发生。.
结论: 改良Stoppa入路联合髂窝入路及Kocher-Langenbeck入路重建钢板内固定治疗复杂髋臼骨折，骨折复位及术后髋关节功能良好，并发症发生率低，近期疗效满意。.
Keywords: Complex acetabular fracture; Kocher-Langenbeck approach; iliac fossa approach; improved Stoppa approach; internal fixation; reconstruction plate; short-term effectiveness.