Therapeutic efficacy of Kocher-Langenbeck approach without cutting hip spin short muscle tendons for treatment of acetabular posterior column fractures

Abstract

Objective To investigate the feasibility and clinical effect of Kocher-Langebeck(K-L)approach without cutting the short external rotator muscles of hip for treatment of cetabular posterior column fractures. Methods A retrospective case series study was performed on 28 patients with acetabular fractures admitted from June 2015 to February 2017.There were 23 males and 5 females, averagely aged 43.6 years (range, 26-71 years). According to the Letournel classification, there were 9 patients with simple fractures, 14 back wall and back pillar fractures and 5 cross fractures. All patients were combined with posterior dislocation. The patients were given tibial tubercle traction after hip joint reduction in the hospital. During the surgery, K-L approach was adopted without cutting the short external rotator muscles of hip. Operation duration and intraoperative bleeding were recorded. Visual analogue score (VAS) was recorded before and after operation. The X-ray at 1 day, 6 weeks, 3 months and 1 year after operation were reviewed to evaluate fracture healing time. Matta criteria were used to assess the surface flatness of joint. The modified Merle d'Aubigne-Postel scoring system was applied to evaluate the function of hip joint. Intraoperative and postoperative complications were recorded. Results The operation duration was 76-120 min (mean, 94 min), and the intraoperative blood loss was 120-320 ml (mean, 265 ml). All patients were followed up for average 16 months (range, 10-24 months). Preoperative VAS was 5-10 points[(7.5±1.3)points], and 0-3 points[(0.9±0.8)points] 6 months after operation (P<0.01). All fractures healed and the average healing duration was 10.1 weeks (range, 6-12 weeks). According to the Matta criteria, 24 patients were graded excellent and 4 good, with excellence rate of 100%. According to the modified Merle d'Aubigne-Postel grading system, clinical results were graded excellent in 23 patients, good in 5, with excellence rate of 100%. Transient sciatic nerve injury occurred in 3 patients after surgery, and the nerve function of these patients fully recovered within 3 months after operation. There were no infection, heterotopic ossification and other complications. The wound healing was good, without liquefaction or cracking. Sciatic nerve injury was found in five patients, three of whom were performed with a transient lesion and recovered within 3 months. Conclusion In the posterior pathway surgery for acetabular posterior column fractures, the K-L approach without cutting the short external rotator muscles of hip can be used to complete the internal fixation with a high rate of fracture healing, sound reduction outcome, satisfactory functional recovery and few complications. Key words: Acetabulum; Hip fractures; Fracture fixation, internal