One-stage combined anterior and posterior approaches for complex double-column acetabular fractures:clinical effect analysis

Liu Dong; Wang Zhiqiang; Chen Lin; Hu Chao

doi:10.3969/j.issn.1009-4237.2025.08.005

Abstract：Objective To explore the efficacy of one-stage ilioinguinal approach combined with Kocher-Langenbeck(K-L)approach for reconstruction and internal fixation of complex double-column acetabular fractures.Methods A retrospective study was conducted on 8 cases of double-column acetabular fractures treated in our de-partment from Jun.2019 to Jun.2023,including 5 males and 3 females aged 45-60(mean 51.5)years.The injury course was 20-47(mean 27.6)d,with 4 road traffic injuries and 4 falls from height.All the 8 patients received one-stage reduction and plate internal fixation via the ilioinguinal approach combined with K-L approach.The char-acteristics of posterior acetabular fractures were summarized.And the reduction quality and hip joint functional re-covery were analyzed.Results Among the 8 cases,6 had posterior wall displacement fractures(1 proximal,1 distal and 2 middle posterior wall displacement,and 2 posterior wall comminution).Of the posterior column fractures,3 were of high level,1 of low level,and 4 of segmental type.The operation time was(4.9±1.2)h and intraoperative bleeding was(1375.0±296.4)mL.One case developed incision infection and achieved union after dressing change and anti-infection therapy.Postoperative lower limb venous ultrasound revealed deep vein thrombosis in another case in the proximal lower limb,for which anticoagulants were given.All patients were followed up for 9-46(mean 28.8)months.According to the Matta scoring criteria for postoperative fracture reduction,there were 4 cases of excellent and 3 of good,with an excellent and good rate of 87.5％.The fracture healing time was(15.1±2.8)weeks.There was 1 case of ectopic ossification and 2 cases of osteoarthritis changes after surgery.At last follow-up,the Merle d'Aubigne-Poster criteria for hip joint function rated 5 cases as excellent,2 as good,and 1 as fair,with an excellent and good rate of 87.5％.Conclusion For low or segmental posterior column fractures with displacement in double-col-umn acetabular fractures,the combined use of anterior and posterior approaches is helpful for the reduction and over-all fixation.Postoperative hip joint function recovery is good,the incidence of complications is low,and the therapeu-tic effect is satisfactory.