Clinical Observation On Operative Treatment Of Quadrilateral Surface Fractures Of Acetabulum Through The Ilioinguinal Approach

Objective:To evaluate the treatment results of quadrilateral surface fractures of the acetabulum fixed with Pelvic reconstruction plate and screws through the ilioinguinal approach by retrospective analysis. Try to provide a new way to improve the treatment of the acetabular fractures.Methods:Analysis cases of quadrilateral surface fractures of the acetabulum in this artical came from the Department of Orthopedics, Wuhan General Hospital of Guangzhou Command from December 2004 to December 2010. The cases who should take three standard Judet X-ray such as anteroposterior hip, obturator oblique, iliac oblique and CT scan of hip routinely before surgery selected based on Inclusion criteria and exclusion criteria, part of the complex cases should be taken three-dimensional computed tomography. The cases would be classified by Letournel-Judet classification of acetabular fracture. Fixing the fractures with pelvic reconstruction plates and screws when reduced satisfactorily via ilioinguinal approach. Crushed in a fixed block quadrilateral surface fractures, as required by the steel drill screws 2 to 5,about 1/2 body length of the screw threads exposed on the outside wall of quadrilateral surface. Review three standard digital X-ray film and CT scan one or two week after surgery hips. Observating the results of fracture reduction and wound healing. After the surgery carried out on patients followed up including clinical examination, three standard digital X-ray examination, fracture healing and fixation conditions. Ask patients about pain, recording the walking posture, measured in patients with hip range of motion, follow-up results would be recorded.Results:Obtain 36 cases of complete clinical data selected from 52 surgical treatment of acetabular fracture cases since December 2004 to December 2010 according to inclusion criteria and exclusion criteria. The degree of reduction standards according to Matta radiological evaluation. There were anatomic reduction in 26 cases, satisfactory reduction in 7 cases, unsatisfactory reduction in 3 cases.36 cases were followed up from 4 to 66 months, average 41.7 months. According to the modified Merle d'Aubigne and Postel's acetabular fracture evaluation standards assessment:excellent in 18, good in 12, fair in 5 and poor in 1,the fine rate was 83.3%.2 case of postoperative wound exudate and superficial infection, by dressing the wound healing after 2 weeks. This group of patients had no iatrogenic femoral nerve, sciatic nerve injury, and the femoral artery and vein damage. There were Inguinal hernia occurred in 6 cases, traumatic arthritis in 1 case, the same bit ossification and avascular necrosis cases.Conclusion:Acetabular fractures involving the quadrilateral surface associated with transverse fractures of the smaller displacement, anterior and posterior hemi-transverse fractures, some T shape fractures and most both column fractures can be treated through the single ilioinguinal approach which can result in good reduction, satisfactory functional recovery, less invasive incision, and low rate of postoperative complications. Pelvic reconstruction plates were placed along the line and fixed with screw.The exposed steel screws were used to maintain the quadrilateral surface fractures on the position steadily as far as possible to achieve anatomical reduction of acetabular fractures. Early surgery, reduction of high-quality, early functional exercise safety is the key to good function.