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.