Research progress of different surgical approaches in treatment of acetabular both-column fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Xiao ^1,2 , LI Ming ^1,2 , LIU Jianheng ^1,2 , LIU Zhongyang ^1,2 , ZHANG Licheng ^1,2 ,  TANG Peifu ^1,2

1. Department of Orthopedics, First Medical Center of the Chinese PLA General Hospital, Beijing, 100853, P.R.China;
2. National Clinical Research Center for Orthopedics Sports Medicine & Rehabilitation, Beijing, 100853, P.R.China;

Corresponding?author：

TANG Peifu, Email: pftang301@163.com

Keywords：

Acetabulum; both-column fractures; surgical approach; research progress

DOI：

10.7507/1002-1892.202012113

Video：

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Objective To review the research progress of different surgical approaches in the treatment of acetabular both-column fractures.Methods The domestic and foreign related research literature on surgical approaches for acetabular both-column fractures was extensively consulted. The anatomical characteristics, exposure ranges, advantages, disadvantages, and indications of various common surgical approaches for both-column fractures were mainly summarized.Results The ilioinguinal approach is more suitable for both-column fractures if the anterior column fracture is complicated or combined with the anterior wall fracture while the posterior column fracture is simple and stable. The modified Stoppa approach or the lateral (para) rectus abdominal approach is the preferred choice when both-column fractures are combined with a quadrilateral fracture or femoral head dislocation. What’s more, the Kocher-Langenbeck approach is required when the posterior column fractures are complicated or combined with posterior wall fractures. In addition, the simultaneous ilioinguinal and Kocher-Langenbeck approaches are the first choices when the both-column fractures possessing extremely severe and obvious displacement.Conclusion The reasonable choice of surgical approach is extremely important for acetabular both-column fractures. Each surgical approach has its advantages and limitations. It is necessary to take the precise reposition of the acetabular joint surface as the principle, and comprehensively judge the fracture types and severity of anterior column, posterior column, and square area, and then select the optimal surgical approach for surgical treatment.

Citation： LIU Xiao, LI Ming, LIU Jianheng, LIU Zhongyang, ZHANG Licheng, TANG Peifu. Research progress of different surgical approaches in treatment of acetabular both-column fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(6): 661-666. doi: 10.7507/1002-1892.202012113 Copy

1.	Letournel E. Acetabulum fractures: classification and management. J Orthop Trauma, 2019, 33 Suppl 2: S1-S2.
2.	Giordano V, Acharya MR, Pires RE, et al. Associated both-column acetabular fracture: An overview of operative steps and surgical technique. J Clin Orthop Trauma, 2020, 11(6): 1031-1038.
3.	Rickman M, Varghese VD. Contemporary acetabular fracture surgery: treading water or swimming upstream? Bone Joint J, 2017, 99-B(9): 1125-1131.
4.	Ziran N, Soles GLS, Matta JM. Outcomes after surgical treatment of acetabular fractures: a review. Patient Saf Surg, 2019, 13: 16. doi: 0.1186/s13037-019-0196-2.
5.	Maini L, Verma T, Sharma A, et al. Evaluation of accuracy of virtual surgical planning for patient-specific pre-contoured plate in acetabular fracture fixation. Arch Orthop Trauma Surg, 2018, 138(4): 495-504.
6.	Chen K, Yang F, Yao S, et al. Application of computer-assisted virtual surgical procedures and three-dimensional printing of patient-specific pre-contoured plates in bicolumnar acetabular fracture fixation. Orthop Traumatol Surg Res, 2019, 105(5): 877-884.
7.	Wang P, Kandemir U, Zhang B, et al. The effect of new preoperative preparation method compared to conventional method in complex acetabular fractures: minimum 2-year follow-up. Arch Orthop Trauma Surg, 2021, 141(2): 215-222.
8.	張瀟, 楊曉東, 夏廣, 等. 經腹直肌外側切口入路重建鋼板輔助后柱順行拉力螺釘治療復雜髖臼骨折. 創傷外科雜志, 2015, 17(2): 123-126.
9.	Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res, 1993, (292): 62-76.
10.	Letournel E. Fractures of the acetabulum: a study of a series of 75 cases—Les fractures du cotyle, etude d'une serie de 75 cas. J de Chirurgie 82:47-87, 1961. (Translated and substantially abridged). J Orthop Trauma, 2006, 20(1 Suppl): S15-S19.
11.	Archdeacon MT. Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum. J Orthop Trauma, 2015, 29 Suppl 2: S6-9.
12.	Chen K, Ji Y, Huang Z, et al. Single modified ilioinguinal approach for the treatment of acetabular fractures involving both columns. J Orthop Trauma, 2018, 32(11): e428-e434.
13.	Leite TFO, Pires LAS, Goke K, et al. Corona Mortis: anatomical and surgical description on 60 cadaveric hemipelvises. Rev Col Bras Cir, 2017, 44(6): 553-559.
14.	Wang P, Zhu X, Xu P, et al. Modified ilioinguinal approach in combined surgical exposures for displaced acetabular fractures involving two columns. Springerplus, 2016, 5(1): 1602.
15.	殷小軍, 芮敏, 任亞軍, 等. 單一髂腹股溝入路治療累及雙柱的髖臼骨折. 中華創傷骨科雜志, 2019, 21(6): 530-534.
16.	王虎, 魏星, 付亞輝, 等. 髂腹股溝入路下拉力螺釘固定后壁在髖臼雙柱骨折手術中的應用. 中華骨科雜志, 2017, 37(13): 771-776.
17.	李連欣, 王永會, 周東生, 等. 骨盆骨折合并髖臼骨折的手術治療. 中華創傷骨科雜志, 2014, 16(5): 396-400.
18.	Wang XJ, Lu Li, Zhang ZH, et al. Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures: A systematic review and meta-analysis. Chin J Traumatol, 2017, 20(4): 229-234.
19.	Archdeacon MT, Kazemi N, Guy P, et al. The modified Stoppa approach for acetabular fracture. J Am Acad Orthop Surg, 2011, 19(3): 170-175.
20.	Kacra BK, Arazi M, Cicekcibasi AE, et al. Modified medial Stoppa approach for acetabular fractures: an anatomic study. J Trauma, 2011, 71(5): 1340-1344.
21.	Kim HY, Yang DS, Park CK, et al. Modified Stoppa approach for surgical treatment of acetabular fracture. Clin Orthop Surg, 2015, 7(1): 29-38.
22.	Ma K, Luan F, Wang X, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics, 2013, 36(10): e1307-e1315.
23.	Shazar N, Eshed I, Ackshota N, et al. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives-Stoppa) surgical approaches. J Orthop Trauma, 2014, 28(6): 313-319.
24.	Hammad AS, El-Khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury, 2015, 46(2): 320-326.
25.	Al Adawy AS, Aziz AHA, El Sherief FA, et al. Modified Stoppa as an alternative surgical approach for fixation of anterior fracture acetabulum: a randomized control clinical trial. J Orthop Surg Res, 2020, 15(1): 154.
26.	Zhang R, Yin Y, Li S, et al. Minimally invasive treatment of both-column acetabular fractures through the Stoppa combined with iliac fossa approach. Sci Rep, 2017, 7(1): 8044. doi: 10.1038/s41598-017-08724-1.
27.	楊曉東, 夏廣, 樊仕才, 等. 單一腹直肌外側切口治療髖臼前后柱骨折. 中華骨科雜志, 2015, 35(4): 335-340.
28.	Wang C, Liu H, Lin X, et al. A single lateral rectus abdominis approach for the surgical treatment of complicated acetabular fractures: a clinical evaluation study of 59 patients. Med Sci Monit, 2018, 24: 7285-7294.
29.	張彬, 李濤, 麥奇光, 等. 經腹直肌外側入路鋼板結合后柱拉力螺釘內固定治療髖臼前后柱骨折. 中國骨與關節損傷雜志, 2017, 32(4): 337-340.
30.	M?rdian S, Schaser KD, Hinz P, et al. Fixation of acetabular fractures via the ilioinguinal versus pararectus approach: a direct comparison. Bone Joint J, 2015, 97-B(9): 1271-1278.
31.	楊方玖, 何斌, 薛黔. 腹直肌形態與肌內神經分布研究及其臨床意義. 中國臨床解剖學雜志, 2009, 27 (5): 529-531.
32.	Alexa O, Malancea R I, Puha B, et al. Results of surgical treatment of acetabular fractures using Kocher-Langenbeck approach. Chirurgia (Bucur), 2013, 108(6): 879-885.
33.	Negrin LL, Benson CD, Seligson D. Prone or lateral? Use of the Kocher-Langenbeck approach to treat acetabular fractures. J Trauma, 2010, 69(1): 137-141.
34.	Siebenrock KA, Gautier E, Ziran BH, et al. Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach. J Orthop Trauma, 2006, 20(1 Suppl): S52-S56.
35.	游景揚, 鄭勇, 白祥軍, 等. 復雜髖臼骨折的手術治療. 中華創傷骨科雜志, 2015, 17(11): 997-999.
36.	張里程, 張立海, 許猛, 等. 髖臼后表面解剖形態測量及新型解剖鎖定鋼板的設計. 中華創傷骨科雜志, 2014, 16(4): 290-294.
37.	馮書鑫. 新型髖臼解剖鎖定鋼板固定髖臼橫行骨折的生物力學研究. 天津: 南開大學, 2014.
38.	周堅鋒. 新型解剖鎖定鋼板固定髖臼T型骨折的有限元分析. 北京: 中國人民解放軍醫學院, 2016.
39.	李碩, 趙陽飛, 張宇, 等. 髖臼骨折手術入路選擇的研究現狀. 中國臨床新醫學, 2020, 13(3): 309-312.
40.	Rawal J, Arshad H, Bates P. Surgical stabilization of acetabular injuries: approaches and methods. Orthopaedics and Trauma, 2018, 32(2): 121-130.
41.	G?nsslen A, Frink M, Hildebrand F, et al. Both column fractures of the acetabulum: epidemiology, operative management and long-term-results. Acta Chir Orthop Traumatol Cech, 2012, 79(2): 107-113.
42.	Pierannunzii L, Fischer F, Tagliabue L, et al. Acetabular both-column fractures: essentials of operative management. Injury, 2010, 41(11): 1145-1149.
43.	Mesbahi SAR, Ghaemmaghami A, Ghaemmaghami S, et al. Outcome after surgical management of acetabular fractures: a 7-year experience. Bull Emerg Trauma, 2018, 6(1): 37-44.
44.	Guerado E, Cano JR, Cruz E. Simultaneous ilioinguinal and Kocher-Langenbeck approaches for the treatment of complex acetabular fractures. Hip Int, 2010, 20 Suppl 7: S2-S10.
45.	Moroni A, Caja VL, Sabato C, et al. Surgical treatment of both-column fractures by staged combined ilioinguinal and Kocher-Langenbeck approaches. Injury, 1995, 26(4): 219-224.
46.	Giannoudis PV, Grotz MR, Papakostidis C, et al. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg (Br), 2005, 87(1): 2-9.
47.	Pavelka T, Houcek P. Complications associated with the surgical treatment of acetabular fractures. Acta Chir Orthop Traumatol Cech, 2009, 76(3): 186-193.
48.	Shon HC, Choi S, Yang JY. Three-dimensional printing-assisted surgical technique with limited operative exposure for both-column acetabular fractures. Ulus Travma Acil Cerrahi Derg, 2018, 24(4): 369-375.
49.	Zhuang Y, Cao S, Lin Y, et al. Minimally invasive plate osteosynthesis of acetabular anterior column fractures using the two-incision minimally invasive approach and a preshaped three dimension plate. Int Orthop, 2016, 40(10): 2157-2162.
50.	Johnson EE, Kay RM, Dorey FJ. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture. Clin Orthop Relat Res, 1994, (305): 88-95.
51.	吳新寶, 王滿宜, 朱仕文, 等. 112例髖臼骨折手術治療結果分析. 中華創傷雜志, 2002, 18(2): 80-84.

1. Letournel E. Acetabulum fractures: classification and management. J Orthop Trauma, 2019, 33 Suppl 2: S1-S2.
2. Giordano V, Acharya MR, Pires RE, et al. Associated both-column acetabular fracture: An overview of operative steps and surgical technique. J Clin Orthop Trauma, 2020, 11(6): 1031-1038.
3. Rickman M, Varghese VD. Contemporary acetabular fracture surgery: treading water or swimming upstream? Bone Joint J, 2017, 99-B(9): 1125-1131.
4. Ziran N, Soles GLS, Matta JM. Outcomes after surgical treatment of acetabular fractures: a review. Patient Saf Surg, 2019, 13: 16. doi: 0.1186/s13037-019-0196-2.
5. Maini L, Verma T, Sharma A, et al. Evaluation of accuracy of virtual surgical planning for patient-specific pre-contoured plate in acetabular fracture fixation. Arch Orthop Trauma Surg, 2018, 138(4): 495-504.
6. Chen K, Yang F, Yao S, et al. Application of computer-assisted virtual surgical procedures and three-dimensional printing of patient-specific pre-contoured plates in bicolumnar acetabular fracture fixation. Orthop Traumatol Surg Res, 2019, 105(5): 877-884.
7. Wang P, Kandemir U, Zhang B, et al. The effect of new preoperative preparation method compared to conventional method in complex acetabular fractures: minimum 2-year follow-up. Arch Orthop Trauma Surg, 2021, 141(2): 215-222.
8. 張瀟, 楊曉東, 夏廣, 等. 經腹直肌外側切口入路重建鋼板輔助后柱順行拉力螺釘治療復雜髖臼骨折. 創傷外科雜志, 2015, 17(2): 123-126.
9. Letournel E. The treatment of acetabular fractures through the ilioinguinal approach. Clin Orthop Relat Res, 1993, (292): 62-76.
10. Letournel E. Fractures of the acetabulum: a study of a series of 75 cases—Les fractures du cotyle, etude d'une serie de 75 cas. J de Chirurgie 82:47-87, 1961. (Translated and substantially abridged). J Orthop Trauma, 2006, 20(1 Suppl): S15-S19.
11. Archdeacon MT. Comparison of the ilioinguinal approach and the anterior intrapelvic approaches for open reduction and internal fixation of the acetabulum. J Orthop Trauma, 2015, 29 Suppl 2: S6-9.
12. Chen K, Ji Y, Huang Z, et al. Single modified ilioinguinal approach for the treatment of acetabular fractures involving both columns. J Orthop Trauma, 2018, 32(11): e428-e434.
13. Leite TFO, Pires LAS, Goke K, et al. Corona Mortis: anatomical and surgical description on 60 cadaveric hemipelvises. Rev Col Bras Cir, 2017, 44(6): 553-559.
14. Wang P, Zhu X, Xu P, et al. Modified ilioinguinal approach in combined surgical exposures for displaced acetabular fractures involving two columns. Springerplus, 2016, 5(1): 1602.
15. 殷小軍, 芮敏, 任亞軍, 等. 單一髂腹股溝入路治療累及雙柱的髖臼骨折. 中華創傷骨科雜志, 2019, 21(6): 530-534.
16. 王虎, 魏星, 付亞輝, 等. 髂腹股溝入路下拉力螺釘固定后壁在髖臼雙柱骨折手術中的應用. 中華骨科雜志, 2017, 37(13): 771-776.
17. 李連欣, 王永會, 周東生, 等. 骨盆骨折合并髖臼骨折的手術治療. 中華創傷骨科雜志, 2014, 16(5): 396-400.
18. Wang XJ, Lu Li, Zhang ZH, et al. Ilioinguinal approach versus Stoppa approach for open reduction and internal fixation in the treatment of displaced acetabular fractures: A systematic review and meta-analysis. Chin J Traumatol, 2017, 20(4): 229-234.
19. Archdeacon MT, Kazemi N, Guy P, et al. The modified Stoppa approach for acetabular fracture. J Am Acad Orthop Surg, 2011, 19(3): 170-175.
20. Kacra BK, Arazi M, Cicekcibasi AE, et al. Modified medial Stoppa approach for acetabular fractures: an anatomic study. J Trauma, 2011, 71(5): 1340-1344.
21. Kim HY, Yang DS, Park CK, et al. Modified Stoppa approach for surgical treatment of acetabular fracture. Clin Orthop Surg, 2015, 7(1): 29-38.
22. Ma K, Luan F, Wang X, et al. Randomized, controlled trial of the modified Stoppa versus the ilioinguinal approach for acetabular fractures. Orthopedics, 2013, 36(10): e1307-e1315.
23. Shazar N, Eshed I, Ackshota N, et al. Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic (modified Rives-Stoppa) surgical approaches. J Orthop Trauma, 2014, 28(6): 313-319.
24. Hammad AS, El-Khadrawe TA. Accuracy of reduction and early clinical outcome in acetabular fractures treated by the standard ilio-inguinal versus the Stoppa/iliac approaches. Injury, 2015, 46(2): 320-326.
25. Al Adawy AS, Aziz AHA, El Sherief FA, et al. Modified Stoppa as an alternative surgical approach for fixation of anterior fracture acetabulum: a randomized control clinical trial. J Orthop Surg Res, 2020, 15(1): 154.
26. Zhang R, Yin Y, Li S, et al. Minimally invasive treatment of both-column acetabular fractures through the Stoppa combined with iliac fossa approach. Sci Rep, 2017, 7(1): 8044. doi: 10.1038/s41598-017-08724-1.
27. 楊曉東, 夏廣, 樊仕才, 等. 單一腹直肌外側切口治療髖臼前后柱骨折. 中華骨科雜志, 2015, 35(4): 335-340.
28. Wang C, Liu H, Lin X, et al. A single lateral rectus abdominis approach for the surgical treatment of complicated acetabular fractures: a clinical evaluation study of 59 patients. Med Sci Monit, 2018, 24: 7285-7294.
29. 張彬, 李濤, 麥奇光, 等. 經腹直肌外側入路鋼板結合后柱拉力螺釘內固定治療髖臼前后柱骨折. 中國骨與關節損傷雜志, 2017, 32(4): 337-340.
30. M?rdian S, Schaser KD, Hinz P, et al. Fixation of acetabular fractures via the ilioinguinal versus pararectus approach: a direct comparison. Bone Joint J, 2015, 97-B(9): 1271-1278.
31. 楊方玖, 何斌, 薛黔. 腹直肌形態與肌內神經分布研究及其臨床意義. 中國臨床解剖學雜志, 2009, 27 (5): 529-531.
32. Alexa O, Malancea R I, Puha B, et al. Results of surgical treatment of acetabular fractures using Kocher-Langenbeck approach. Chirurgia (Bucur), 2013, 108(6): 879-885.
33. Negrin LL, Benson CD, Seligson D. Prone or lateral? Use of the Kocher-Langenbeck approach to treat acetabular fractures. J Trauma, 2010, 69(1): 137-141.
34. Siebenrock KA, Gautier E, Ziran BH, et al. Trochanteric flip osteotomy for cranial extension and muscle protection in acetabular fracture fixation using a Kocher-Langenbeck approach. J Orthop Trauma, 2006, 20(1 Suppl): S52-S56.
35. 游景揚, 鄭勇, 白祥軍, 等. 復雜髖臼骨折的手術治療. 中華創傷骨科雜志, 2015, 17(11): 997-999.
36. 張里程, 張立海, 許猛, 等. 髖臼后表面解剖形態測量及新型解剖鎖定鋼板的設計. 中華創傷骨科雜志, 2014, 16(4): 290-294.
37. 馮書鑫. 新型髖臼解剖鎖定鋼板固定髖臼橫行骨折的生物力學研究. 天津: 南開大學, 2014.
38. 周堅鋒. 新型解剖鎖定鋼板固定髖臼T型骨折的有限元分析. 北京: 中國人民解放軍醫學院, 2016.
39. 李碩, 趙陽飛, 張宇, 等. 髖臼骨折手術入路選擇的研究現狀. 中國臨床新醫學, 2020, 13(3): 309-312.
40. Rawal J, Arshad H, Bates P. Surgical stabilization of acetabular injuries: approaches and methods. Orthopaedics and Trauma, 2018, 32(2): 121-130.
41. G?nsslen A, Frink M, Hildebrand F, et al. Both column fractures of the acetabulum: epidemiology, operative management and long-term-results. Acta Chir Orthop Traumatol Cech, 2012, 79(2): 107-113.
42. Pierannunzii L, Fischer F, Tagliabue L, et al. Acetabular both-column fractures: essentials of operative management. Injury, 2010, 41(11): 1145-1149.
43. Mesbahi SAR, Ghaemmaghami A, Ghaemmaghami S, et al. Outcome after surgical management of acetabular fractures: a 7-year experience. Bull Emerg Trauma, 2018, 6(1): 37-44.
44. Guerado E, Cano JR, Cruz E. Simultaneous ilioinguinal and Kocher-Langenbeck approaches for the treatment of complex acetabular fractures. Hip Int, 2010, 20 Suppl 7: S2-S10.
45. Moroni A, Caja VL, Sabato C, et al. Surgical treatment of both-column fractures by staged combined ilioinguinal and Kocher-Langenbeck approaches. Injury, 1995, 26(4): 219-224.
46. Giannoudis PV, Grotz MR, Papakostidis C, et al. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg (Br), 2005, 87(1): 2-9.
47. Pavelka T, Houcek P. Complications associated with the surgical treatment of acetabular fractures. Acta Chir Orthop Traumatol Cech, 2009, 76(3): 186-193.
48. Shon HC, Choi S, Yang JY. Three-dimensional printing-assisted surgical technique with limited operative exposure for both-column acetabular fractures. Ulus Travma Acil Cerrahi Derg, 2018, 24(4): 369-375.
49. Zhuang Y, Cao S, Lin Y, et al. Minimally invasive plate osteosynthesis of acetabular anterior column fractures using the two-incision minimally invasive approach and a preshaped three dimension plate. Int Orthop, 2016, 40(10): 2157-2162.
50. Johnson EE, Kay RM, Dorey FJ. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture. Clin Orthop Relat Res, 1994, (305): 88-95.
51. 吳新寶, 王滿宜, 朱仕文, 等. 112例髖臼骨折手術治療結果分析. 中華創傷雜志, 2002, 18(2): 80-84.

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