| Objective:The objective of this study was to explore and compare the clinical efficacy of single anterior approach(Modified stoppa approach)and combined anterior and posterior approach(Modified stoppa +K-L approach)used in the treatment of both-column acetabular fracture.Methods:1.Retrospectively analyzed twenty patients with both-column acetabular fractures(Judet-Letournel classification)who were surgically treated by the same group of orthopedists in our hospital from January 2018 to March 2020。According to the surgical approach,divided these patients into two groups A and B.Patients in group A were treated by modified stoppa approach,7 males and 4 females were contained inside,a total of 11 cases.And the age was from 25 to 56 years old,with an average of 36.82±9.60 years old.While the patients in group B were treated by modified stoppa+K-L approach,including 6 males and 3 females,a total of 9 cases.The age from 28 to 60 years,with an average of 40.33±11.62 years.Patients in both groups received complete preoperative and postoperative X-ray and CT three-dimensional reconstruction of the pelvic.The operative duration,bleeding during operation,the fracture healing time after operation,both-column acetabular fracture reduction and hip function were compared between the two groups.Clinical Matta criteria was used to evaluate fracture reduction and Harris scale was used to evaluate the hip function of postoperative.2.Selection of an adult male with pelvic CT scan,the CT scan of pelvic acetabulum data import Mimics,Geomagics and Hypermesh software for processing,and established respectively in the ABAQUS acetabulum double column fracture model,a single fixed anterior acetabulum double column fractures and joint into the road treatment acetabulum double column before and after internal fixation of fracture finite element model,compare the way in two different internal fixation,acetabulum double column fracture internal fixation system of biomechanics.Results:1.In the follow-up of patients in the two groups,no complications were founded such as poor wound healing,wound infection,postoperative nonunion,failure of postoperative internal fixation,necrosis of the femoral head.The postoperative followed up time of group A range from 9 to 13 months,with an average of 10.82 ± 1.47 months.The operative time was 2.58±0.37 h,the average bleeding during the operation was 527.27±88.67 ml,and the average postoperative fracture healing time was 13.27±1.19 weeks.The reduction quality of both-column acetabular fracture treated by modified Stoppa approach was excellent in 3 cases,good in 7 cases and 1 case was poor.The excellent ratio in group A was 90.91%.The Harris hip function score of group A was excellent in 8 cases,good in 2 cases and fair in 1 case.The excellent ratio was72.73%.The patients in group B were followed up for 9 to 15 months,with an average of11.11±1.96 months.The average operative time was 4.39±0.27 h,the average bleeding during the operation was 1111.11 ± 194.90 ml,and the average time of the fracture healing after operation was 12.78 ± 0.83 weeks.The reduction quality of both-column acetabular fracture treated by modified Stoppa+K-L approach was excellent in 3 cases,good in 5 cases and 1 case was poor.The excellent ratio in group B was 88.89%.The Harris hip function score in group B was excellent in 6 cases,good in 2 cases and fair in1 case.The excellent and good rate was 66.67%.One patient developed lower limb numbness after surgery and recovered after 4 weeks of mecobalamin treatment.There were significant differences in the operative time and intraoperative blood loss between the two groups,the difference was statistically significant(P < 0.05).On the contrary,there was no significant difference in the postoperative fracture healing time,fracture reduction quality and hip joint functional score and there were no statistically significant differences between the two groups(P > 0.05).2.There was no significant difference in the amount of acetabular strain displacement between the two types of both-column acetabular fracture internal fixation models;In the model of both-column acetabular fracture with single anterior fixation,the maximum stress was concentrated in the anterior acetabular column,the top of the acetabular and the quadripartite area;In the model of both-column acetabular fracture fixed by anterior combined with posterior approach,the stress was evenly distributed,the maximum stress was concentrated at the top of the acetabulum,and the stress in the quadripartite area was significantly reduced;The maximum stress of femoral neck in the model of both-column acetabular fracture fixed by a single anterior approach was greater than that in the model of both-column acetabular fracture fixed by a combined anterior and posterior approach.Conclusion:1.For patients with both-column acetabular fractures,the posterior surgical approach is not necessary if satisfactory postoperative efficacy can be obtained after anterior fixation.2.In the both-column acetabular fracture model with a single anterior fixation,no additional stress was observed in the posterior column,but the stress was more concentrated in the quadrisquare zone and the neck of the femur than in the model with a combined anterior and posterior approach.Therefore,from a biomechanical perspective,there is no need for additional posterior approach for acetabular double-column fractures stabilized by anterior fixation.However,for the elderly patients with traumatic femoral head necrosis tendency,lower limb line deformity,osteoporosis or extreme obesity,the combination of anterior and posterior approach is better. |
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