The Anatomic And Clinical Study Of Surgery Approach In Acetabular Fracture By CTA

Objective:To evaluate the clinical significance of CTA on surgical approach chosen in acetabular fracture.Methods:(1)Seventy-four cases of acetabular fracture were retrispectively study,in order to look for the problems of acetabular fracture in the treatment;(2) The morphological characteristics of the artery around acetabulum and adjacent relationship between these tissues were observed in 15 samples of 30 sides acetabular;(3) CTA were performed to 10 cases of acetabular fracture,in order to propose measures to reduce blood loss,then preliminarily observed the clinical efficacy.Result:(1) Seventy cases were followed up for 1 year to 4 years,on a average of 16 months,4 cases lost,achieving a 94.5%followup rate,Curative effective were according to Mattas's evaluation system,X-ray criteria,44cases(62.9%) reached anatomical reduction,18 cases (25.7%) gained imperfect reduction and 8 cases(11.4%) resulted in unsatisfactory reduction;Complications:9 cases(12.9%) of sciatic nerve injury,12 cases(17.1%) of venous thrombosis,11 cases(15.7%) of osteonecrosis of the femoral head,6 cases(8.5%) of traumatic arthritis,6 cases(8.5%) of heterotopic ossification,1 case(1.4%) of nonunion,2 cases(2.8%) of infection and 1 case(1.4%) of death,respectively;(2) Superior gluteal artery,internal pudendal artery,inferior gluteal artery close to external iliac bone plate,the distance from Superior gluteal artery to the greater sciatic notch is shortest.At the lateral position,the posterior superior iliac spine,greater sciatic notch,femur greater trochanter project to constitute a isosceles triangle;(3)Ten patients were followed up for 12 months to 24 months,on a average of 16 months, according to Matta efficacy evaluation criteria,clinical criteria:8 cases were excellent,1 case was good,1 case was acceptable,the excellent and good rate was 90%;X-ray:7 cases reached anatomical reduction,1 cases gained imperfect reduction,2 cases resulted in unsatisfactory reduction;The blood loss were from 400ml to 1500ml,on an average of 820ml.Conclusion: (1) The complications of acetabular fracture are related to types of fractures,reduction, surgical approach;(2) Superior gluteal artery and variation of the inferior gluteal artery are more easily injured when fracture involved the greater sciatic notch,the blood loss is large,and it is difficult to stop bleeding;(3) At the lateral position,the posterior superior iliac spine,greater sciatic notch,femur greater trochanter project to constitute a isosceles triangle which is useful in improving acetabular fracture surgical approach and reducing blood loss;(4) CTA is good at showing patterns and types of acetabular fracture,block the artery around the acetabular,the relationship between the artery and the morphological changes and the artery wall damage,which supply an objective and visual basis for acetabular farcture surgical approach opion and prognosis evaluation.