Surgical Treatment Of Displaced Complex Acetabular Fractures Through A Combined Ilioinguinal And Kocher-Langenbeck Approach

Background:With the increase of traffic accidents and industrial accidents in recent years,acetabularfractures is dramatically increasing trend.Acetabular fractures is serious injury,and often merge the loss of other parts of the complex injuries because the anatomicallocation of the acetabulum is deep, surrounded by rich muscles ligaments andother soft tissue.Secondly, the acetabular fractures are intra-articular fracture,the processing requirements need to achieve anatomic reduction as far aspossible, restore the function of the hip joint, otherwise the legacy of jointdysfunction, and even the joints complete loss of function;Furthermore, asorthopedic surgeons recently come to gradually realize that a reasonable openreduction and internal fixation can be achieved better efficacy, better than theprevious conservative treatment. However, the types of acetabular fractures iscomplex. Open reduction surgery is very difficult, it need high technology, andsurgical trauma, bleeding, etc. Therefore, surgical treatment of acetabularfractures in recent years become the research focus of orthopedic surgeons.Objective:To explore the surgical treatment of displaced complex acetabularfractures with the combined anterior ilio-inguinal and posterior Kocher-Langenbenk approaches.Methods:From January2008to December2011,The clinical data of28cases of displacedcomplex acetabular fractures treated with a combined ilioinguinal andKocher-Langenbeck approach were studied retrospectively. There were14males and4females, with a mean age of42years (range from25to64years).The operating time, the volume of intra-operative blood loss and blood transfusions,fracture healing time, complications were recorded. Thereduction was radiologically evaluated based on the criteria described by Matta.At the final follow-up, the patients were evaluated clinically according to theModified Harris hip score and d′Aubigne-Postel scoring system.Result: The patients were followed up in July to36months, the operativetime was80~120min, intraoperative blood loss was8002000mL bloodtransfusion400~1000mL. The postoperative wound healed, no sciatic nerveinjury, deep venous thrombosis, alienation ossification complications. By Mattareset Standards: satisfactory reduction of23cases, unsatisfactory reduction ofthree cases, fractures were excellent rate of96.4%. Joint function in accordancewith the modified Merle d Aubigne-postel scoring system to assess jointfunction, excellent rate:85.7%.Conclusion: through a combined ilioinguinal and Kocher-Langenbeckapproach can effectively improve the exposure and the quality of reduction ofcomplex acetabular fractures, reduce surgical time, blood loss and surgicalcomplications.