Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Comparative Results of Acetabular Both Column Fracture According to the Fixation Method

고정 방법에 따른 양 지주 비구 골절의 수술적 치료 결과 비교

  • Lee, Kyung-Jae (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Min, Byung-Woo (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Son, Eun-Seok (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Seo, Hyuk-Jun (Department of Orthopedic Surgery, School of Medicine, Keimyung University) ;
  • Park, Jin-Hyun (Department of Orthopedic Surgery, School of Medicine, Keimyung University)
  • 이경재 (계명대학교 의과대학 정형외과학교실) ;
  • 민병우 (계명대학교 의과대학 정형외과학교실) ;
  • 손은석 (계명대학교 의과대학 정형외과학교실) ;
  • 서혁준 (계명대학교 의과대학 정형외과학교실) ;
  • 박진현 (계명대학교 의과대학 정형외과학교실)
  • Published : 2011.06.30
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Abstract

Purpose: We wanted to compare the clinical and radiological results of surgical treatment of acetabular both column fracture according to the fixation method. Materials and Methods: Between 1986 and 2008, 55 patients who underwent surgical treatment for acetabular both column fracture were clinically and radiologically evaluated after a minimum follow-up of one year. Of 55 patients, 29 cases were operated with a cerclage wire or cable (group I) and 26 cases were operated with a plate and screw (group II). The surgical approach, the intra- and post-operative complications and the reduction quality were compared between the two groups. The clinical and radiological results were analyzed according to the criteria reported by Matta. Results: There were 14 (48.3%)/20 (76.9%) cases of anatomical reduction, 12 (41.4%)/6 (23.1%) cases of imperfect reduction, 1/0 case of poor reduction and 2/0 cases of surgical secondary incongruence, respectively. Thirty three patients of 34 anatomically reduced patients showed excellent clinical results and the anterior and posterior combined approach was frequent in group I. There were no differences between the two groups for the complications, although intraoperative complication was more frequent in group II and postoperative complication was more frequent in group I. Conclusion: The clinical and radiological results of surgical treatment in patients with both column fracture were satisfactory in both groups. However, the concerns related to the surgical approach and complications will require a randomized prospective study.

목적: 양 지주 비구 골절 환자의 수술적 치료 후 고정 방법에 따른 결과를 비교해 보고자 하였다. 대상 및 방법: 1986년부터 2008년까지 양 지주 비구 골절로 수술적 치료를시행하고 1년 이상 추시 관찰이 가능하였던 55예를 대상으로 하였으며 금속 강선 또는 케이블 고정이 29예 (I군), 금속판 및 나사못 고정이 26예 (II군)였다. 고정 방법에 따른 수술적 접근법, 골절의 정복 상태 및 합병증을 비교하였으며 임상적 및 방사선학적 치료 결과는 Matta의 기준에 따라 평가하였다. 결과: 양 군의 골절 정복 상태는 해부학적 정복 14예(48.3%)/20예(76.9%), 불완전 정복 12예(41.4%)/6예(23.1%), 불량 정복 1예/0예, surgical secondary incongruence 2예/0예였다. 해부학적 정복을 보였던 34예 중 33예에서 임상적으로 우수한 결과를 보였으며 I군에서 전후방 동시 도달법이 사용된 예가 더 많았다. 수술 중 합병증은 II군에서, 수술 후 합병증은 I군에서 더 많이 발생하였으나 통계학적인 유의성은 없었다. 결론: 양 지주 비구 골절 환자에서 두군 모두 만족할 만한 임상적 및 방사선학적 결과를 보였으나 수술적 접근법, 합병증 등에 대해서는 더 많은 환자군을 대상으로 한 전향적 연구가 필요할 것으로 사료된다.

Keywords

References

  1. Kim SK, Suh SW. Surgical treatment of acetabular fracture. J Korean Soc Fract. 1994;7:422-30.
  2. Min BW, Lee KJ. Complications in patients with acetabular fractures treated surgically. J Korean Fract Soc. 2008;21:341-6.
  3. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78:1632-45.
  4. Min BW, Nam SY, Kang CS. Complications of surgical treatment in patients with acetabular fractures. J Korean Hip Soc. 2000;12:253-60.
  5. Gansslen A, Krettek C. Internal fixation of acetabular both-column fractures via the ilioinguinal approach. Oper Orthop Traumatol. 2009;21:270-82. https://doi.org/10.1007/s00064-009-1804-6
  6. Kang CH, Lee KJ, Min BW, Jung JH. Indirect reduction of posterior column through ilioinguinal approach in case of both column fractures. J Korean Hip Soc. 2009;21:334-8.
  7. Chen CM, Chiu FY, Lo WH, Chung TY. Cerclage wiring in displaced both-column fractures of the acetabulum. Injury. 2001;32:391-4. https://doi.org/10.1016/S0020-1383(00)00243-6
  8. Kang CS, Min BW. Cable fixation in displaced fractures of the acetabulum: 21 patients followed for 2-8 years. Acta Orthop Scand. 2002;73:619-24.
  9. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach. A 10-year perspective. Clin Orthop Relat Res. 1994;305:10-9.
  10. Matta JM, Anderson LM, Epstein HC, Hendricks P. Fractures of the acetabulum. A retrospective analysis. Clin Orthop Relat Res. 1986;205:230-40.
  11. Kim SK, Park JH, Park JW, Hong JS, Kim JH. Significance of anatomic reduction in acetabular fracture. J Korean Soc Fract. 2000;13:724-32.
  12. fractures of the acetabulum. Results in 163 fractures. Clin Orthop Relat Res. 1994;305:31-7.
  13. Letournel E. Acetabular fracture: classification and management. Clin Orthop Relat Res. 1980;151:81-106.
  14. Yoon TR, Jung SN, Park SJ, Song EK. Internal fixation with pelvic plate for displaced acetabular fracture. J Korean Soc Fract. 2000;13:733-40.
  15. Kang CS, Kim SY. The analysis of clinical results of acetabular fractures after open reduction and internal fixation with wire. J Korean Hip Soc. 1989;1:1-11.
  16. Kim CK, Jin JW, Yoon JH, Jung SW, Peang JW. Cerclage wiring in internal fixation of displaced acetabular fractures. J Korean Fract Soc. 2008;21:95-102.
  17. Letournel E, Judet R. Fractures of the acetabulum. 2nd ed. NewYork: Springer-Verlag; 1993. 545-57.