Surgery through single ilioinguinal approach for treatment of complex acetabular fractures

WANG Hui-biao; WANG Wu-chao

doi:10.3969/j.issn.1009-4237.2018.05.011

Abstract：Objective To explore the clinical curative effects of internal fixation through single ilioinguinal approach for treatment of complex acetabular fractures.Methods The medical records of 24 patients with complex acetabular fractures who were followed up from Feb.2014 to Aug.2016 were analyzed retrospectively.The patients consisted of 18 males and 6 females,and ranged in age from 25 to 55 years(median=39.6 yrs).The causes of inju-ry included traffic accident injury in 15 cases,falling injury in 6 cases and crush-related injury in 3 cases.According to the Letournel-Judet classification of acetabular fractures,there were 13 cases of dual-column fractures,6 cases of anterior column accompanied with the latter part transverse fractures and 5 cases of T-shaped fractures.All patients were treated with single ilioinguinal approach,and the posterior column fractures were fixed with lag-screws under the help of guide apparatus of posterior cruciate ligament(PCL)reconstruction.The operative time and intra-opera-tive blood loss were recorded,the fracture reduction situations were evaluated by using Matta imaging scores and the clinical curative effects were evaluated by using improved d'Aubigne and Postel hip scores.Results The surgery were finished successfully in all patients.The surgical time ranged from 2 to 4 hours with an average of 2.5 hours and the intraoperative blood loss ranged from 700 to 1900 mL with an average of 850.3 mL.Eleven patients needed blood transfusion and the blood transfusion volume ranged from 600 mL to 1000 mL with an average of 700.4 mL. At the 2nd day after surgery,the fracture reduction situations were evaluated by using Matta imaging scores.Sixteen patients obtained anatomical reduction,in which 8 patients achieved good results.All patients were followed up for 12-18 months with an average of 14.5 months,and all fractures healed in 10-16 weeks with an average of 12.5 weeks.At the last follow-up,the hip joint function was evaluated according to d'Aubigne and Postel Hip joint scoring system,showing excellent results in 15 patients,good in 7 patients and fair in 2 patients,with scores of(17.46 ± 4.33)points.Conclusion The posterior column can be fixed with screws effectively and safely under the help of guide apparatus of PCL reconstruction during the internal fixation surgery in treating complex acetabular fracture through single ilioinguinal approach,with advantages of little damage and good fracture fixation.It is helpful for frac-ture healing and functional recovery of hip joint.However,this approach requires a high degree of proficiency for surgeon.