| Background:In recent years,the incidence of acetabular fractures caused by traffic accidents has been increasing.Acetabular fractures without surgery for more than 21 days after injury were defined as old acetabular fractures by Letoumel and Judet.Compared with early acetabular fractures,the anatomic reduction of old acetabular fractures is more difficult and satisfaction rate of reduction is lower.In addition,the incidence of postoperative traumatic arthritis is higher than early acetabular fractures and the rate of Total joint replacement is also higher.For the old acetabular fractures involving only a single column or a single wall,most foreign scholars also recommended the use of a single extended approach for surgery,because the wide range of intraoperative exposure is conductive to the complete release of the fracture end.However,for the fractures involving double columns,most scholars at home and abroad advocated the combined anterior and posterior approach for surgery.They believed that the combined anterior and posterior approach has a wide exposure range and could ralease the fractures ends from the front and rear,so as to facilitate the use of collaborative reduction technology to complete the reduction.We believe that both single extended approach and combined anterior and posterior approach have problems such as long operation time,large trauma,multiple bleeding,iatrogenic nerve injury and heterotopic ossification.In recent years,lateral rectus abdominis approach has been applied more and more in acetabular fracture surgery due to its advantages such as sufficient exposure of acetabular double columns,less surgical trauma and fewer complications.A large number of anatomical and clinical studies have proved that acetabular surgery through this approach is safe and effective.Since no literature has reported the treatment of old acetabular fractures through this approach,our team began to conduct clinical studies on the treatment of old acetabular fractures through this approach since 2014.This paper retrospectively analyzed the clinical date of 17 patients with old acetabular fractures admitted in our hospital between January 2014 and January 2016.Purpose:This study aims to explore the surgical methods of exposure,reduction and fixation through the single lateral-rectus approach for the treatment of old actabular fractures and to make a short-term restrospective clinical efficacy evaluation.Methods:According to whether intraoperative osteotomy has been done,17 patients were divided into two groups,namely the non-osteotomy group and noteotomy group.Basic information,fracture type,injury mechanism,causes of fresh acetabular fracture development to old fracture,operation time,intraoperative blood loss,reduction,functional recovery and postoperative complications of each group were statistically analyzed.Preoperatively,the acetabular model was reconstructed and printed using Mimics 3D software and detailed surgical planning was made.The reduction acetabular model was printed by the mirror image principle,and the plate was pre-bent on the model to prepare for operation.For patients with severe osteoporosis,preoperative customized variable-angle locking acetabular wing plates was made for fixation in operation.All patients underwent surgery through the single lateral-rectus approach.Pelvic orthography,oblique iliac,obturator oblique X-Ray,pelvic CT-scan and three-dimensional reconstruction were reexamined 48h after surgery.Matta imaging criteria were used to evaluate the quality of fracture reduction and healing.The patients were followed up at 4 weeks,12 weeks,6 months,lyear,2 years,and 18 months after surgery to evaluate the hip function according to the modified Merle D’Aubigne and Postel score.Results:1.non-osteotomy group:A total of 13 patients in this group,the average operation time from injury to surgery was 43 days,the average operation time was 130min,and the average intraoperative bleeding was 850ml.Among them,2 cases were fixed with customized plates,and 1 leases were fixed with reconstruction plates.The reduction quality;anatomic reduction in 7 cases,satisfactory in 4 cases,unsatisfactory in 2 cases,overall excellent and good rate of 84.6%.Postoperative complications:incision subcutaneous fat liquefaction in 1 case,temporary hip joint adduction weakness in 1 case;No perioperative complications such as neurovascular injury and deep venous thrombosis of lower limbs were found.All patients were followed up for an average of 2 years.All fractures were healed clinically with an average healing time of 2 months.Hip function were assessed according to the modified Merle D’Aubigne and Postel score:excellent in 7 cases,good in 3 cases,acceptable in 2 cases,poor in 1 case,overall excellent and good rate of 76.9%.During the follow-up,2 cases of traumatic hip arthritis were found,and none of them had internal fixation failure such as screw and steel plate fracture.2.osteotomy group:A total of 4 patients in this group,the average operation time from injury to surgery was 76 days,the average operation time was Z12min,and the average intraoperative bleeding was 1585ml.1 cases were fixed with customized plates,and 3 cases were fixed with reconstruction plates.The reduction quality:anatomic reduction in 2 cases,satisfactory in 2 cases.All patients were followed ou for an average of 2 years.Temporary hip joint adduction weakness in 1 case.No perioperative complications such as neurovascular injury and deep venous thrombosis of lower limbs were found.All fractures were healed clinically with an average healing time of 3 months.Hip function were assessed according to the modified Merle D’Aubigne and Postel score:excellent in 2 cases,good in 2 cases.During the follow-up,1 cases of traumatic hip arthritis were found,and none of them had internal fixation failure such as screw and steel plate fracture.Conclusions:In the treatment of the old acetabular fractures(except the posterior wall fracture),the fracture ends can be ftully exposed,the good reduction and fixation can be achieved via the single lateral-rectus approach. |
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