Simultaneous The Modified Stoppa And Iliac Fossa Approaches For The Treatment Of The Involved Double Columns Acetabular Fractures With Acetabulum Top Compression Fracture

Simultaneous the modified Stoppa and iliac fossa approaches for the treatment of the involved double columns acetabular fractures with acetabulum top compression fracture Objective:For acetabular double-column fractures accompanied by acetabular compression,we identified a surgical approach that is easy to operate,fully exposed and conducive to the exact fixation of fractures,namely,modified Stoppa approach combined with iliac fossa approach,To clarify the early surgical treatment of acetabular double-column frac-tures accompanied by acetabular compression by this surgical approach provides strong evidence for its clinical application.Materials and Methods:Collect and follow-up Our hospital from April 2016 to June 2017 in line with Jude-Letournel classification standdard double column fracture accompanied by acetabular compression in 11 patients,but not associated with acetabular posterior wall fractures,including 7 males,Female 4 cases.Among the 9 patients collected,there were 9 cases of traffic accident and 2 cases of falling injury.All were high-energy injuries.Aged 40-58 years,mean 50.5 years old,left 6 cases,right 5 cases,are closed injury.Three patients suffered from central dislocation of the femoral head after operation,and were given manualreduction.Eleven patients were all given preoperative and postoperative supracondylar femoral condyle traction.The above patients were treated with modified Stoppa approach completely exposed on the affected side of the suprapubic branch,iliac shame,quadrilateral,acetabular posterior column medial,true pelvic margin,ischial bone and sacroiliac joint,Late- ral iliac wing,acetabulum posterior column and the sacroiliac joint,reset the column,reset the articular surface and impaction of bone graft and post-fracture reduction,placement of steel plate,screw fixation fractures,intraoperative x-ray pelvis anteroposterior position,closed Oblique inclination of the hole,iliac oblique,to determine the satisfaction of fracture reduction,adjusting the screw into the nail direction and angle,intraoperative recording of patients with surgical bleeding,recording the operation time and intraoperative complications.Postoperative reconstructions of X-ray and CT were performed.Acetabular fractures and articular surface were evaluated according to modified Matta criteria.Hip joint function was evaluated systematically according to Matta modified Merle d'Aubigné and Postel score 6 months after surgery.Results:All the 11 patients completed the operation successfully.The operation time ranged from 2.1 to 4.5 hours,with an average of 3.1 hours.The intraoperative blood loss was 800-1600 ml,with an average of1100 ml.All patients underwent allogeneic blood transfusion andintraoperative blood transfusion of 400-800 ml.After reconstruction,according to the modified Matta standard,9 cases were evaluated for anatomic reduction and 2 cases were reset well.Eleven patients were followed up.The follow-up was performed by the surgeon.The follow-up time ranged from 6 to 20 months(mean,12.7 months).All patients received acetabular fractures with bony union for 3-5 months with an average of 3.7 months.According to the modified Merle d'Aubigné and Postel evaluation criteria,hip function was excellent in 6 cases,good in 3cases,fair in 2 cases and poor in 1 case.The excellent and good rate was81.8%(9/11).One case of intraoperative bladder rupture,given timely repair.Two patients developed traumatic arthritis.After oral admini-stration of non-steroidal anti-inflammatory drugs,the symptom relief was obvious and no special treatment was given.One patient had hete-rotopic ossification without any obvious clinical symptoms and no special treatment.Conclusion:The modified Stoppa approach combined with iliac crest approach for the treatment of acetabular double-column fractures with acetabular compression shows a good operative field,which can provide sufficient operating space for fracture reduction,bone graft and internal fixation,with a lower risk,Early clinical results are reliable,it is worth further promotion.