Analysis Of The Operative Outcomes In 36 Cases With Complicated Acetabular Fracture

Objective To explore the relevant factors with the operative outcomes of complicated acetabular fracture (CAF) that the study summarized the diagnosis and treatment. Especially to improve the operative outcomes of CAF and to provide some clinical evidence by analyzing the effect relationships of the seven relevant factors which were classification of fracture, dislocation of femoral head operative timing, operative approaches, diaplastic quality of fracture, heterotopic ossification(HO) and rehabilitation exercise to the operative outcomes.Methods From July 2005 to July 2010,36 cases of all complicated acetabular fracture which had been operated were collected from the orthopedics department of No.5 (zhuhai) affiliated hospital of zunyi medical college. In this group,there were 26 men and 10 women with an average age of 36.03 years(range 23-52 years).All of the patients were evaluated classification of fracture, dislocation of femoral head and diaplastic quality of fracture to CAF by using the preoperative X radiographs(including PAV,IOV and OOV),CT and (or) 3-D CT and the postoperative X radiographs(PAV).The related factors which wound explored in this study were grouped as follows:(1)The classification of fracture with all patients were divided into 5 groups by referring to the Letournel classification about CAF;(2)The dislocation of femoral head with all patients were divided into the groups of without dislocation and central dislocation and posterior dislocation(there were not the patients of anterior dislocation); (3)The operative timing of all patients were segmented into 3 groups which were the groups of<7 days and 8-21 days and>21 days respectively; (4) In this study,operative approaches of all patients were separated into the groups of ilioinguinal approach(IIA),Kocher-Langenbeck approach (KLA) and anterioposterior combined approach;(5)The diaplastic quality of fracture for all patients were divided into the groups of anatomical reduction,satisfactory reduction and unsatisfactory reduction by using Matta' X-ray reduction criterion;(6)According to the classification of Brooker to evaluate the degree of HO which were separated into the groups of none of HO and slight of HO and severe of HO;(7)According to the time of passive flex activities for the hip rehabilitation exercise of all patients were divided into the group of≤7 days and the group of>7 days;(8) The operative outcomes which was expressed by postoperative hip function were scored by the modified Merle d'Aubigne-Postelevaluation standard, and the results were showed such as excellent,good,fair and poor.When we used the statistical analysis,the results were divided into two groups:one group included excellent and good,the other included fair and poor. The operative outcomes which might been affected by the possible relevant factors, such as classification of fracture, dislocation of femoral head,operative timing, operative approaches,diaplastic quality of fracture, HO and rehabilitation exercise, were used as univariate analysis,there were the statistically significant which were showed by p<0.05.The relevant factors with statistically significant were used as logistic multi-factor regression analysis furtherly.Results Univariate analysis showed that the differences of the operative outcomes with classification of fracture and operative approach were not statistically significant (p>0.05);and the differences of the operative outcomes with dislocation of femoral head,operative timing, diaplastic quality of fracture,HO and rehabilitation exercise were statistically significant (p<0.05);The relevant factors which were statistical significance such as dislocation of femoral head,operative timing, HO and rehabilitation exercise were showed by logistic multi-factor regression analysis that dislocation of femoral head and operative timing were independent risk factors for the operative outcomes, and rehabilitation exercise was independent protection factor for the operative outcomes.Conclusion (1)Anatomical reduction is the most important factor to achieve good operative outcomes;(2)Dislocation of femoral head, operative timing and diaplastic quality of fracture might be independent risk factors of the operative outcomes with CAF; rehabilitation exercise might be the independent protection factor of the operative outcomes with CAF;severe of HO may be the one of the influence fator for the operative outcomes;(3) TO improve the operative outcomes,the surgery and the early passive flex function exercise of the injury side hip shuod be done in less than or equal to 7 days under the situation allowde.The results of this subject suggested that we wound improved the operative outcomes of CAF if we could base on the correct preoperative classification of fracture,appropriate operative timing, suitable operative approaches, favourable diaplastic quality of fracture, strong internal fixation, effective prevention of serious HO and reasonable rehabilitation exercise.