Treatment of Acetabulum Fractures Through the Modified Stoppa Approach: Strategies and Outcomes
详细信息 查看全文
- 作者：Mark J. Isaacson DO ; Benjamin C. Taylor MD…
- 刊名：Clinical Orthopaedics and Related Research?
- 出版年：2014
- 出版时间：November 2014
- 年：2014
- 卷：472
- 期：11
- 页码：3345-3352
- 全文大小：989 KB
- 参考文献：1. Cole JD, Bolhofner BR. Acetabular fracture fixation via a modified Stoppa limited intrapelvic approach: description of operative technique and preliminary treatment results. / Clin Orthop Relat Res. 1994;305:112-23. CrossRef
2. Goulet JA, Bray TJ. Complex acetabular fractures. / Clin Orthop Relat Res. 1989;240:9-0.
3. Hirvensalo E, Lindahl J, Kitjunen V. Modified and new approaches for pelvic and acetabular surgery. / Injury. 2007;38:431-41. CrossRef
4. Jakob M, Droeser R, Zobrist R, Messmer P, Regazzoni P. A less invasive anterior intrapelvic approach for the treatment of acetabular fractures and pelvic ring injuries. / J Trauma. 2006;60:1364-370. CrossRef
5. Karunakar MA, Le TT, Bosse MJ. The modified ilioinguinal approach. / J Orthop Trauma. 2004;18:379-83. CrossRef
6. Kebaish AS, Roy A, Rennie W. Displaced acetabular fractures: long-term follow-up. / J Trauma. 1991;31:1539. CrossRef
7. Letournel E. Acetabulum fractures: classification and management. / Clin Orthop Relat Res. 1980;151:81.
8. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. / Clin Orthop Relat Res. 1993;292:62-6.
9. Letournel E, Judet R. / Fractures of the Acetabulum. 2nd ed. Berlin, Germany: Springer-Verlag; 1993. CrossRef
10. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach. / Clin Orthop Relat Res. 1994;305:10-9. CrossRef
11. Merle d’Aubigne R, Postel M. Functional results of hip arthroplasty with acrylic prosthesis. / J Bone Joint Surg Am. 1954;36:451.
12. Ponsen KJ, Joosse P, Schigt A, Goslings JC, Goslings CJ, Luitse JS. Internal fracture fixation using the Stoppa approach in pelvic ring and acetabular fractures: technical aspects and operative results. / J Trauma. 2006;61:662-67. CrossRef
13. Probe R, Reeve R, Lindsey RW. Femoral artery thrombosis after open reduction of an acetabular fracture. / Clin Orthop Relat Res. 1992;283:258-60.
14. Sagi H, Afsari A, Dziadosz D. The anterior intra-pelvic (modified Rives-Stoppa) approach for fixation of acetabular fractures. / J Orthop Trauma. 2010;24:263-70. CrossRef
15. Stoppa RE. The treatment of complicated groin and incisional hernias. / World J Surg. 1989;13:545-54. CrossRef - 作者单位：Mark J. Isaacson DO (1)
Benjamin C. Taylor MD (2) (3)
Bruce G. French MD (2)
Attila Poka MD (2)
1. Department of Orthopaedic Surgery, Doctors-Hospital, Columbus, OH, USA
2. Department of Orthopaedic Surgery, Grant Medical Center, Columbus, OH, USA
3. OhioHealth Orthopaedic Trauma and Reconstructive Surgery, Grant Medical Center, 285 East State Street, Suite 500, Columbus, OH, 43215, USA - ISSN：1528-1132
文摘
Background Since the original description by Letournel in 1961, the ilioinguinal approach has remained the predominant approach for anterior acetabular fixation. However, modifications of the original abdominal approach described by Stoppa have made another option available for reduction and fixation of pelvic and acetabular fractures. Questions/purposes We evaluated our results in patients with acetabulum fractures with the modified Stoppa approach in terms of (1) hip function as measured by the Merle d’Aubigne hip score; (2) complications; and (3) quality of fracture reduction and percentage of fractures that united. Methods Between September 2008 and August 2012, 289 patients with acetabular fractures were treated at our Level I trauma center. Twelve percent (36 of 289) of patients were treated operatively using the modified Stoppa approach. Ninety-seven percent (35 of 36) of our patients had fracture patterns involving displacement of the posterior column. Six (17%) were converted early to a total hip arthroplasty, and 14 (39%) were lost to final followup, leaving 22 of 36 for subjective clinical outcome analysis at a mean of 32 months (range, 9-9 months). Our general indications for this approach during the period in question were fractures of the anterior column and anterior wall, anterior column with posterior hemitransverse fractures, both column fractures, transverse fractures, and T-type fractures. Followup included regularly scheduled office visits with radiographs (AP pelvis, Judet views) that were graded by the treating surgeon and by the authors of this study (MJI, BCT) and patient outcome surveys. Results Merle d’Aubigne hip scores were very good in 55% (12 of 22), good in 9% (two of 22), medium in 18% (four of 22), fair in 5% (one of 22), and poor in 14% (three of 22), and 70% (23 of 33) of patients were able to ambulate without any assistive devices. Complications included one superficial infection and three deep infections, two patients with temporary lateral thigh numbness, no obturator nerve palsies, and one inguinal hernia. Three deaths in the cohort were seen in followup as a result of unrelated causes. Radiographic grading of fracture reductions after surgery revealed that 27 (75%) were anatomic, six (17%) were satisfactory, and three (8%) were unsatisfactory. A total of 94% of the fractures united. Conclusions In agreement with prior published data, our results show good functional outcomes with minimal complications using the modified Stoppa approach for a variety of acetabular fractures. Our results highlight the difficulty but feasibility in treating posterior column displacement through an anterior approach. Consideration for dual approaches with posterior column involvement may be warranted to optimize fracture reduction and functional outcomes. Level of Evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.