ObjectiveTo compare the effectiveness between modified ilioinguinal approach combined with Kocher-Langenbeck (K-L) approach and Stoppa approach combined with K-L approach for the treatment of complicated acetabular fractures.MethodsBetween May 2011 and May 2016, Sixty-two patients with complicated acetabular fractures were treated with operation via combined anterior and posterior approaches. Thirty-four cases (group A) were treated with modified ilioinguinal approach combined with K-L approach, and 28 cases (group B) were treated with Stoppa approach combined with K-L approach. There was no significant difference in gender, age, injury causes, the type of fracture, time from injury to operation, and associated injury between 2 groups (P>0.05). The operation time, intraoperative blood loss, and hospitalization time were recorded. X-ray film was performed to evaluate the fracture reduction according to the Matta reduction criteria and observe the fracture healing, osteoarthritis, and heterotopic ossification. Clinical results were evaluated according to the grading system of modified d’Aubigne and Postel.ResultsThere was no significant difference in operation time, intraoperative blood loss, and hospitalization time between 2 groups (P>0.05). Postoperative incision fat liquefaction occurred in 2 cases in group A and group B respectively, and deep vein thrombosis of lower extremity occurred in 1 case in group A. No iatrogenic injury was found in 2 groups. Fifty-six patients were followed up after operation. Thirty patients in group A were followed up 12-48 months (mean, 31.8 months). Twenty-six patients in group B were followed up 12-46 months (mean, 30.2 months). At 12 months after operation, according to the grading system of modified d’Aubigne and Postel, the hip function was rated as excellent in 9 cases, good in 16 cases, fair in 3 cases, and poor in 2 cases, with the excellent and good rate of 83.3% in group A; the hip function was rated as excellent in 7 cases, good in 14 cases, fair in 2 cases, and poor in 3 cases, with the excellent and good rate of 80.8% in group B. There was no significant difference in the hip function between 2 groups (Z=0.353, P=0.724). The X-ray films showed that there were 23 cases of anatomical reduction, 6 cases of satisfactory reduction, and 1 case of unsatisfactory reduction in group A, and 20 cases, 5 cases, and 1 case in group B, respectively. There was no significant difference in the results of fracture reduction between 2 groups (Z=0.011, P=0.991). Fracture healing was observed in both groups. There was no significant difference in fracture healing time between 2 groups (t=0.775, P=0.106). During follow-up, 5 cases of osteoarthritis changes, 2 cases of heterotopic ossification, and 2 cases of avascular necrosis of femoral head occurred in group A, and 4 cases, 2 cases, and 1 case in group B, respectively. The difference between 2 groups was not significant (P>0.05).ConclusionAccording to the location and type of fracture, making a choice between the modified anterior approach and Stoppa approach, and then combined with K-L approach for treatment of complicated acetabular fracture, can obtain satisfactory effectiveness.
ObjectiveTo investigate the mid-term effectiveness of periacetabular osteotomy (PAO) through modified ilioinguinal approach for acetabular dysplasia in adults. MethodsBetween January 2016 and December 2018, 39 patients (43 hips) with acetabular dysplasia who met the selection criteria were enrolled in the study and their clinical data were retrospectively analyzed. All patients were treated with PAO via modified ilioinguinal approach (firstly, the skin and superficial facia were cut via the traditional ilioinguinal approach, and the deep tissues were cut via the modified iliac-femoral approach). There were 3 males (3 hips) and 36 females (40 hips) with an average age of 36 years (range, 18-51 years). Among them, 35 cases of lesions involved single hip and 4 cases of lesions involved bilateral hips. The disease duration ranged from 4 to 96 months, with a median of 18 months. According to the modified Tönnis grading for osteoarthritis, 35 hips were classified as grade 0, 6 hips as grade Ⅰ, and 2 hips as grade Ⅱ. All patients had different degrees of hip pain. The preoperative visual analogue scale (VAS) score of pain was 4.7±0.8, and the modified Harris hip score was 78.5±8.6. The lateral centre-edge angle (LCEA) was (10.52±10.83)°, and the acetabular index (AI) was (26.89±9.07) °. The operation time, intraoperative blood loss, and the incidence of complications were recorded. LCEA, AI, and the progression of osteoarthritis were reviewed by X-ray films. The function and pain of hip joint were evaluated by modified Harris hip score and VAS score. ResultsAll operations were successfully completed. The operation time was 90-150 minutes, with an average of 130 minutes. The volume of intraoperative blood loss was 350-600 mL, with an average of 500.6 mL. All patients were followed up 17-52 months, with an average of 32.7 months. Postoperative numbness of the lateral femoral cutaneous nerve occurred in 3 cases, and no other complications occurred. At last follow-up, the modified Harris hip score was 97.7±3.7 and VAS score was 0.9±1.1, both of which were better than those before operation (P<0.05). At 1 year after operation, X-ray films showed that the all osteotomies healed. In term of the modified Tönnis grading for osteoarthritis, 1 hip downgraded from grade 1 to grade 0, while the remaining hips stayed unchanged. At last follow-up, LCEA and AI were (27.54±8.49) ° and (11.30±5.53) °, respectively, which were significantly different from those before operation (P<0.05). ConclusionPAO through modified ilioinguinal approach is effective in relieving pain and restoring hip function in adults with acetabular dysplasia, which can overcome the disadvantages of the traditional ilioinguinal approach, and may delay the development of osteoarthritis.
Objective To explore the surgical skills of modified Gibson combined with modified ilioinguinal (MGMII) approach in the treatment of Enneking Ⅱ+Ⅲ pelvic malignant tumors in the three-dimensional (3D) printed customized integrated hemipelvic prosthesis, and to evaluate the convenience and accuracy of the surgical approach and the short-term effectiveness. Methods Between January 2017 and March 2019, 7 patients with Enneking Ⅱ+Ⅲ pelvic malignant tumors were treated with tumor resection and 3D printed hemipelvic prosthesis replacement via MGMII approach. There were 6 males and 1 female. The age ranged from 23 to 68 years, with an average of 43.7 years. There was 1 chondrosarcoma, 1 Ewing’s sarcoma, 1 osteosarcoma, 1 malignant Schwannoma, 2 metastatic renal clear cell carcinoma, and 1 metastatic hepatocellular carcinoma. The Enneking stage of 4 cases of primary malignant tumor was stage ⅡB. The disease duration was 6-12 months, with an average of 9.5 months. The preoperative Harris hip score (HHS) was 82.1±1.4 and the Musculoskeletal Tumor Society (MSTS) score was 21.4±1.1. The tumor size by imaging examination was 5.1-9.1 cm, with an average of 6.9 cm. The operation time, intraoperative blood loss, postoperative blood transfusion volume, and postoperative complications were recorded. Postoperative pathological examination confirmed tumor residue according to R classification criteria. The lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle were measured and the bone integration was observed by imaging review. Bilateral abductor muscle strengths were measured, and joint function was evaluated by MSTS score and HHS score. Results All operations were successfully completed. The operation time was 210-360 minutes (mean, 280.0 minutes); the intraoperative blood loss was 1 300-2 500 mL (mean, 1 785.7 mL); the postoperative blood transfusion volume was 0-11 U (mean, 6.1 U). Postoperative pathological examination confirmed R0 resection assisted by osteotomy guide plate. All incisions healed by first intention. All patients were followed up 30-48 months (mean, 41.3 months). At last follow-up, the imaging review showed the good osseointegration in all 7 cases. There was no significant difference in the lower limb length, acetabular height, acetabular eccentricity, abduction angle, and anteversion angle between the affected side and the healthy side (P>0.05), all of which met the requirements of anatomical reconstruction. At 3 months after operation, the ratios of muscle strength between the affected side and the healthy side was 68.29%±7.41% at 3 months and 89.86%±2.79% at 12 months, showing a significant difference between the two time points (t=8.242, P=0.000). At last follow-up, the MSTS score and HHS score were 27.3±0.8 and 96.6±1.4, respectively, which significantly improved when compared with those before operation (P<0.05). None of the patients had assisted walking at last follow-up. There was no recurrence, death, or complications such as deep infection, dislocation of the prosthesis, or fracture of the prosthesis or screw. Conclusion MGMII approach can expose the posterior column of the acetabulum, especially the ischial tubercle, which is helpful to avoid tumor rupture during tumor resection and preserve the muscle functions such as gluteus medius and iliac muscle while ensuring the resection scope.