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.	张潇, 杨晓东, 夏广, 等. 经腹直肌外侧切口入路重建钢板辅助后柱顺行拉力螺钉治疗复杂髋臼骨折. 创伤外科杂志, 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.	殷小军, 芮敏, 任亚军, 等. 单一髂腹股沟入路治疗累及双柱的髋臼骨折. 中华创伤骨科杂志, 2019, 21(6): 530-534.
16.	王虎, 魏星, 付亚辉, 等. 髂腹股沟入路下拉力螺钉固定后壁在髋臼双柱骨折手术中的应用. 中华骨科杂志, 2017, 37(13): 771-776.
17.	李连欣, 王永会, 周东生, 等. 骨盆骨折合并髋臼骨折的手术治疗. 中华创伤骨科杂志, 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.	杨晓东, 夏广, 樊仕才, 等. 单一腹直肌外侧切口治疗髋臼前后柱骨折. 中华骨科杂志, 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.	张彬, 李涛, 麦奇光, 等. 经腹直肌外侧入路钢板结合后柱拉力螺钉内固定治疗髋臼前后柱骨折. 中国骨与关节损伤杂志, 2017, 32(4): 337-340.
30.	Märdian 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.	杨方玖, 何斌, 薛黔. 腹直肌形态与肌内神经分布研究及其临床意义. 中国临床解剖学杂志, 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.	游景扬, 郑勇, 白祥军, 等. 复杂髋臼骨折的手术治疗. 中华创伤骨科杂志, 2015, 17(11): 997-999.
36.	张里程, 张立海, 许猛, 等. 髋臼后表面解剖形态测量及新型解剖锁定钢板的设计. 中华创伤骨科杂志, 2014, 16(4): 290-294.
37.	冯书鑫. 新型髋臼解剖锁定钢板固定髋臼横行骨折的生物力学研究. 天津: 南开大学, 2014.
38.	周坚锋. 新型解剖锁定钢板固定髋臼T型骨折的有限元分析. 北京: 中国人民解放军医学院, 2016.
39.	李硕, 赵阳飞, 张宇, 等. 髋臼骨折手术入路选择的研究现状. 中国临床新医学, 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.	Gänsslen 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.	吴新宝, 王满宜, 朱仕文, 等. 112例髋臼骨折手术治疗结果分析. 中华创伤杂志, 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. 张潇, 杨晓东, 夏广, 等. 经腹直肌外侧切口入路重建钢板辅助后柱顺行拉力螺钉治疗复杂髋臼骨折. 创伤外科杂志, 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. 殷小军, 芮敏, 任亚军, 等. 单一髂腹股沟入路治疗累及双柱的髋臼骨折. 中华创伤骨科杂志, 2019, 21(6): 530-534.
16. 王虎, 魏星, 付亚辉, 等. 髂腹股沟入路下拉力螺钉固定后壁在髋臼双柱骨折手术中的应用. 中华骨科杂志, 2017, 37(13): 771-776.
17. 李连欣, 王永会, 周东生, 等. 骨盆骨折合并髋臼骨折的手术治疗. 中华创伤骨科杂志, 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. 杨晓东, 夏广, 樊仕才, 等. 单一腹直肌外侧切口治疗髋臼前后柱骨折. 中华骨科杂志, 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. 张彬, 李涛, 麦奇光, 等. 经腹直肌外侧入路钢板结合后柱拉力螺钉内固定治疗髋臼前后柱骨折. 中国骨与关节损伤杂志, 2017, 32(4): 337-340.
30. Märdian 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. 杨方玖, 何斌, 薛黔. 腹直肌形态与肌内神经分布研究及其临床意义. 中国临床解剖学杂志, 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. 游景扬, 郑勇, 白祥军, 等. 复杂髋臼骨折的手术治疗. 中华创伤骨科杂志, 2015, 17(11): 997-999.
36. 张里程, 张立海, 许猛, 等. 髋臼后表面解剖形态测量及新型解剖锁定钢板的设计. 中华创伤骨科杂志, 2014, 16(4): 290-294.
37. 冯书鑫. 新型髋臼解剖锁定钢板固定髋臼横行骨折的生物力学研究. 天津: 南开大学, 2014.
38. 周坚锋. 新型解剖锁定钢板固定髋臼T型骨折的有限元分析. 北京: 中国人民解放军医学院, 2016.
39. 李硕, 赵阳飞, 张宇, 等. 髋臼骨折手术入路选择的研究现状. 中国临床新医学, 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. Gänsslen 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. 吴新宝, 王满宜, 朱仕文, 等. 112例髋臼骨折手术治疗结果分析. 中华创伤杂志, 2002, 18(2): 80-84.

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