| Objiectives: Retrospective analysis of the ilioinguinal approach,Kocher-Langgenbeck(K-L)approach,anterior and posterior combined approach for the treatment of acetabular both-column fractures.Methods: A total of 39 patients with acetabular both-column fractures were collected in the Orthopaedic Department of Xiangtan Central Hospital with certain diagnostic standard from January 2014-August 2018 which adopted the ilioinguinal approach,Kocher-Langgenbeck(K-L)approach for the treatment of acetabular both-column fractures.39 cases were divided into three groups according to the surgical approach,including 13 cases of single ilioinguinal approach group(group A),10 cases of single K-L approach group(group B),16 cases of combined ilioinguinal approach and K-L approach(group C).Then,we carried out retrospective analysis and research on them.The patients were followed up for 6-54 months with an average follow-up of36.4 months.The excellent rate of fracture reduction quality and the excellent rate of joint function,and joint function improvement Merle d'Aubigné and Postal scores were compared between group A,B andC.Then,we counted the occurrence of complicationsResults: 1 The quality of postoperative reduction was assessed by Matta [1] imaging standard.The excellent rate of reduction of group A was 46.2%,the good rate was 38.5%,and the poor rate was 15.3%.The excellent rate of reduction of group B was 50.0%,the good rate was 30.0%,and the poor rate was 20.0%.The excellent rate of reduction of group C was 87.5%,the good rate was 6.25%,and the poor rate was 6.25%.The difference of the excellent rate of the three groups was statistically significant(P=0.033<0.05).The difference between the A?B group was not statistically significant.The difference between the A ? C group was statistically significant.The difference between the B ? C group was statistically significant.The difference of the excellent and good rate of the three groups was not statistically significant(P=0.58>0.05).The evaluation of hip function according to the modified Merle d'Aubigné and Postal [2]: The excellent rate of postoperative joint function in group A was 38.46%,the good rate was 38.46%,the poor rate was 23.08%;The excellent rate of postoperative joint function in group B was 40.0%,the good rate was 30.0%,the poor rate was 30.0%;The excellent rate of postoperative joint function in group C was 81.25%,the good rate was6.25%,the poor rate was 12.50%;The difference of postoperative joint function between the three groups was statistically significant(P=0.039<0.05).There was no significant difference in the excellent andgood rate of postoperative joint function between the three groups(P=0.64>0.05).The modified Merle d'Aubigné and Postal scores were(15.38±2.90)points in group A 6 months after surgery and(14.80±3.92)points in group B,(17.31 ± 1.74)points in group C.The modified Merle d'Aubigné and Postal scores were statistically significant in three groups6 months after surgery.The modified Merle d'Aubigné and Postal scores were statistically significant between group A and B 6 months after surgery.There were one cases of postoperative traumatic arthritis in group A,B and C.One case of avascular necrosis of femoral head occurred in group A,and none in group B of group C.There was no heterotopic ossification in group A,and one case of heterotopic ossification occurred in both groups B and C.There had not important nerve damage and infection in any groups.The differences were not statistically significant in postoperative complications between the three groups.Conclusion: 1.Compared with a single ilioinguinal approach or K-L,the ilioinguinal approach combined with the K-L approach for the treatment of the acetabular both-column fractures can fully expose the surgical field,which is beneficial to fracture reduction and fracture fixation.and is ideal surgical approach for acetabular both-column fractures.2.The quality of fracture reduction is closely related to postoperative joint function. |
PDF Full Text Request