Kocher-Langenbeck approach combined with screw technique for the treatment of complex acetabular fractures / 中华骨科杂志

ABSTRACT

Objective@#To evaluate the efficacy and reliability of K-L approach combined with screw technique for the treatment of acetabular transverse combined with T shaped fractures.@*Methods@#Data of 17 patients with acetabular fractures who were treated by K-L approach combined with screw technique from April 2015 to April 2018 were retrospectively analyzed. There were 11 males and 6 females, aged 28-69 years (mean, 44 years). Injury mechanism: 11 cases were car accident injuries, 4 cases from fall injuries, and 2 cases from ski injury. Letournel-Judet classification: 11 cases in the front with the posterior transverse, 6 cases in the T-shaped (including 3 cases T-shaped plus the posterior wall). The time from injury to surgery was 3-20 days, with an average of 9.8 days. All cases were treated by single K-L approach open reduction and internal fixation. The hip joint function was evaluated by hip Harris score and the Matta's improved Merle d'Aubigné-Postel scores system.@*Results@#All the 17 patients were followed up for 7-26 months with an average of 14 months. The operation time was 171-310 min, with an average of 220 min. The intraoperative blood loss was 360-1 800 ml with an average of 810 ml. All the patients were healed. The healing time was 2-3 months, with an average of 2.5 months. The Matta's improved Merle d'Aubigné-Postel scores was 10-18 points, with an average of 16.7 points. The results were excellent in 12 cases, good in 3 cases, fair in 1 case, and poor in 1 case. The excellent and good rate was 88.2% (15/17). The Harris score at the latest follow-up was 69-96 points, with an average of 88 points. Among them, 10 cases were excellent, 4 cases good, 2 cases fair, and 1 case was poor. The excellent and good rate was 82.4% (14/17). Four patients had deep venous thrombosis of the lower extremities. The deep venous thrombosis of the lower extremities was found at 1-3 days after operation. The thrombus disappeared after 3 months of anticoagulant therapy with low molecular weight heparin. Sensory motor ability decreased in 8 cases after surgery because of sciatic never injury. After mecobalamin drug therapy, 7 patients recovered within 2-3 months, and 1 patient recovered 6 to 12 months later. Eight patients had heterotopic ossification, according to Brooker classification, there were 5 cases of grade I, 2 of grade II and 1 of grade III.@*Conclusion@#K-L approach combined with screw technique for the treatment of complex acetabular fractures has satisfactory clinical results but may potentially increase the risk of sciatic nerve injury.