Short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Guozhao ^1,2 , MO Jianqiang ² , ZHANG Yong ² , LI Rongqun ² , YANG Huilin ² ,  SHI Jinhui ²

1. Department of Orthopedics, the First People’s Hospital of Zhangjiagang, Zhangjiagang Jiangsu, 215600, P. R. China;
2. Department of Orthopedics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P. R. China;

Corresponding author：

SHI Jinhui, Email: shijinhui502@126.com

Keywords：

Complex acetabular fracture; improved Stoppa approach; iliac fossa approach; Kocher-Langenbeck approach; reconstruction plate; internal fixation; short-term effectiveness

DOI：

10.7507/1002-1892.202206104

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures. Methods Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days). Results The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d’Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred. Conclusion For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.

Citation： CHEN Guozhao, MO Jianqiang, ZHANG Yong, LI Rongqun, YANG Huilin, SHI Jinhui. Short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(12): 1453-1458. doi: 10.7507/1002-1892.202206104 Copy

1.	Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg (Am), 1965, 46(8): 1615-1646.
2.	Paksoy AE, Topal M, Aydin A, et al. Outcomes of surgical management of acetabular fractures treated with anterior approaches. Eurasian J Med, 2019, 51(3): 257-261.
3.	Chen J, Liu H, Wang C, et al. Internal fixation of acetabular fractures in an older population using the lateral-rectus approach: short-term outcomes of a retrospective study. J Orthop Surg Res, 2019, 14(1): 4. doi: 10.1186/s13018-018-1039-z.
4.	樊仕才, 刘涵, 黄复铭. 髋臼骨折手术入路选择的原则与复位固定技巧. 中华骨科杂志, 2021, 41(1): 58-66.
5.	Moed BR, Israel HA. Which anterior acetabular fracture surgical approach is preferred? A survey of the orthopaedic trauma association active membership. J Orthop Trauma, 2020, 34(4): 216-220.
6.	Manson TT. Open reduction and internal fixation plus total hip arthroplasty for the acute treatment of older patients with acetabular fracture: Surgical techniques. Orthop Clin North Am, 2020, 51(1): 13-26.
7.	Letournel E. Acetabulum fracture: classification and management. Clin Orthop, 1980, (151): 81-106.
8.	Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. J Orthop Trauma, 2006, 20(1 Suppl): S20-S29.
9.	Moed BR, Willsoncarr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg (Am), 2002, 84(5): 752-758.
10.	Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
11.	孙俊英, 唐天驷, 董天华, 等. 移位复杂型髋臼骨折的手术治疗. 中华骨科杂志, 2002, 22(5): 300-303.
12.	Gänsslen A, Grechenig S, Nerlich M, et al. Standard approachesto the acetabulum part 1: Kocher-Langenbeck approach. Acta Chir Orthop Traumatol Cech, 2016, 83(3): 141-146.
13.	杨德顺, 王洋洋, 王开明, 等. 经改良Stoppa入路跟骨钢板桥接重建钢板固定治疗累及方形区的髋臼骨折. 中国修复重建外科杂志, 2020, 34(10): 1253-1257.
14.	田思宇, 王忠正, 张英泽, 等. 改良Stoppa入路与髂腹股沟入路钢板内固定治疗髋臼前柱/前壁骨折的疗效比较. 中华创伤杂志, 2020, 36(11): 977-982.
15.	Routt ML Jr, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg (Am), 1990, 72(6): 897-904.
16.	李来峰, 王辉, 赵学春, 等. 改良Stoppa入路联合髂嵴前入路及K-L入路治疗复杂髋臼骨折合并骨盆骨折. 中国矫形外科杂志, 2015, 23(18): 1716-1718.
17.	杨帆, 黄振飞, 陈开放, 等. 组合式钢板治疗累及前柱、前壁的髋臼骨折. 中华骨科杂志, 2019, 39(13): 796-802.
18.	Briffa N, Pearce R, Hill AM, et al. Outcomes of acetabular fracture fixation with ten years follow-up. J Bone Joint Surg (Br), 2011, 93(2): 229-236.
19.	王志强, 冯皓宇, 马迅, 等. 3D打印人工椎体及椎间融合器在颈椎前路手术中应用的临床效果. 中国修复重建外科杂志, 2021, 35(9): 1147-1154.
20.	Horas K, Hoffmann R, Faulenbach M, et al. Advances in the preoperative planning of revision trauma surgery using 3D printing technology. J Orthop Trauma, 2020, 34(5): e181-e186.
21.	姚升, 郭晓东, 陈开放, 等. 3D打印个性化体外导板辅助经皮微创置钉治疗骨盆髋臼骨折. 中华创伤骨科杂志, 2019, 21(6): 471-477.

1. Judet R, Judet J, Letournel E. Fractures of the acetabulum: Classification and surgical approaches for open reduction. Preliminary report. J Bone Joint Surg (Am), 1965, 46(8): 1615-1646.
2. Paksoy AE, Topal M, Aydin A, et al. Outcomes of surgical management of acetabular fractures treated with anterior approaches. Eurasian J Med, 2019, 51(3): 257-261.
3. Chen J, Liu H, Wang C, et al. Internal fixation of acetabular fractures in an older population using the lateral-rectus approach: short-term outcomes of a retrospective study. J Orthop Surg Res, 2019, 14(1): 4. doi: 10.1186/s13018-018-1039-z.
4. 樊仕才, 刘涵, 黄复铭. 髋臼骨折手术入路选择的原则与复位固定技巧. 中华骨科杂志, 2021, 41(1): 58-66.
5. Moed BR, Israel HA. Which anterior acetabular fracture surgical approach is preferred? A survey of the orthopaedic trauma association active membership. J Orthop Trauma, 2020, 34(4): 216-220.
6. Manson TT. Open reduction and internal fixation plus total hip arthroplasty for the acute treatment of older patients with acetabular fracture: Surgical techniques. Orthop Clin North Am, 2020, 51(1): 13-26.
7. Letournel E. Acetabulum fracture: classification and management. Clin Orthop, 1980, (151): 81-106.
8. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach: a 10-year perspective. J Orthop Trauma, 2006, 20(1 Suppl): S20-S29.
9. Moed BR, Willsoncarr SE, Watson JT. Results of operative treatment of fractures of the posterior wall of the acetabulum. J Bone Joint Surg (Am), 2002, 84(5): 752-758.
10. Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
11. 孙俊英, 唐天驷, 董天华, 等. 移位复杂型髋臼骨折的手术治疗. 中华骨科杂志, 2002, 22(5): 300-303.
12. Gänsslen A, Grechenig S, Nerlich M, et al. Standard approachesto the acetabulum part 1: Kocher-Langenbeck approach. Acta Chir Orthop Traumatol Cech, 2016, 83(3): 141-146.
13. 杨德顺, 王洋洋, 王开明, 等. 经改良Stoppa入路跟骨钢板桥接重建钢板固定治疗累及方形区的髋臼骨折. 中国修复重建外科杂志, 2020, 34(10): 1253-1257.
14. 田思宇, 王忠正, 张英泽, 等. 改良Stoppa入路与髂腹股沟入路钢板内固定治疗髋臼前柱/前壁骨折的疗效比较. 中华创伤杂志, 2020, 36(11): 977-982.
15. Routt ML Jr, Swiontkowski MF. Operative treatment of complex acetabular fractures. Combined anterior and posterior exposures during the same procedure. J Bone Joint Surg (Am), 1990, 72(6): 897-904.
16. 李来峰, 王辉, 赵学春, 等. 改良Stoppa入路联合髂嵴前入路及K-L入路治疗复杂髋臼骨折合并骨盆骨折. 中国矫形外科杂志, 2015, 23(18): 1716-1718.
17. 杨帆, 黄振飞, 陈开放, 等. 组合式钢板治疗累及前柱、前壁的髋臼骨折. 中华骨科杂志, 2019, 39(13): 796-802.
18. Briffa N, Pearce R, Hill AM, et al. Outcomes of acetabular fracture fixation with ten years follow-up. J Bone Joint Surg (Br), 2011, 93(2): 229-236.
19. 王志强, 冯皓宇, 马迅, 等. 3D打印人工椎体及椎间融合器在颈椎前路手术中应用的临床效果. 中国修复重建外科杂志, 2021, 35(9): 1147-1154.
20. Horas K, Hoffmann R, Faulenbach M, et al. Advances in the preoperative planning of revision trauma surgery using 3D printing technology. J Orthop Trauma, 2020, 34(5): e181-e186.
21. 姚升, 郭晓东, 陈开放, 等. 3D打印个性化体外导板辅助经皮微创置钉治疗骨盆髋臼骨折. 中华创伤骨科杂志, 2019, 21(6): 471-477.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content