MODIFIED Stoppa APPROACH WITH MEDIAL WALL SPRING PLATE FOR INVOLVING QUADRILATERAL OF ACETABULUM FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANGYajun , YUEJianming ,  WENPeng

Department of Orthopedics, Ningxia People's Hospital, Yinchuan Ningxia, 750001, P. R. China;

Corresponding?author：

WENPeng, Email: wp61516@sina.com

Keywords：

Modified Stoppa approach; Medial wall spring plate; Acetabulum fracture; Quadrilateral

DOI：

10.7507/1002-1892.20150058

Video：

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Objective To investigate the effectiveness of modified Stoppa approach with medial wall spring plate (MWSP) for involving quadrilateral of acetabulum fracture. Methods Between March 2008 and September 2013, 38 patients with involving quadrilateral of acetabulum fracture were treated, including of 23 males and 15 females with an average age of 36.08 years (range, 19-56 years). The causes included traffic accidents injury (21 cases), crash injury of heavy object (10 cases), and falling injury from height (7 cases). The interval of injury and admission was 3 hours to 2 days (mean, 11 hours). There were 12 cases of anterior column fracture (type D), 5 cases of transverse fractures (type E), 8 cases of T shaped fractures (type H), 6 cases of anterior column fracture with posterior transverse fractures (type I), and 7 cases of double column fractures (type J) according to Letournel-Judet classification. Based on fracture types, MWSP was used to fix fracture by modified Stoppa approach in 19 cases or combined with the ilioinguinal approach in 10 cases or combined with Kocher-Langenbeck approach in 9 cases. The operation time, blood loss, and complications were recorded. The effectiveness of reduction and the hip function were evaluated according to Matta score system and Merled' Aubigne and Postel score system. Results The operation time was 85-210 minutes (mean, 130 minutes).The intra-operative blood loss was 450-900 mL (mean, 650 mL). There were 1 case of vascular avulsion, and 1 case of bladder injury during operation; there were 8 cases of venous thrombosis and 2 cases of fat liquefaction of incision after operation. Screw was implanted into the articular joint in 1 case on CT after operation. Matta X-ray assessment showed anatomical reduction in 9 cases, satisfactory reduction in 24 cases, and unsatisfactory reduction in 5 cases, and the satisfaction rate of reduction was 86.84%. Three patients had limb shorting of 0.8-1.0 cm when compared with normal limb. All patients were followed up for 7 to 18 months with an average of 10 months. Fractures healed well within 13-16 weeks with an average of 14 weeks. At 1 year after operation, the results were excellent in 9 cases, good in 21 cases, general in 5 cases, and poor in 3 cases, and the excellent and good rate was 78.95% according to the Merled'Aubigne and Postel hip score standards. Conclusion Involving quadrilateral of acetabulum fracture can be fixed with MWSP by modified Stoppa approach or combined with other approaches to obtain good exposure, less invasion, satisfactory reduction, stable fixation, and low complications.

Citation： YANGYajun, YUEJianming, WENPeng. MODIFIED Stoppa APPROACH WITH MEDIAL WALL SPRING PLATE FOR INVOLVING QUADRILATERAL OF ACETABULUM FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 270-274. doi: 10.7507/1002-1892.20150058 Copy

1.	秦曉東, 李翔, 呂天潤, 等. 改良髂腹股溝下入路治療髖臼骨折的解剖研究和臨床應用. 中國修復重建外科雜志, 2014, 28(1):47-52.
2.	Ruan Z, Luo CF, Zeng BF, et al. Percutaneous screw fixation for the acetabular fracture with quadrilateral plate involved by three-dimensional fluoroscopy navigation:surgical technique. Injury, 2012, 43(4):517-521.
3.	S.Terry Canale, James H.Beaty. 坎貝爾骨科手術學. 王巖, 唐佩福, 譯. 北京:人民軍醫出版社, 2013:2575-2581.
4.	禹寶慶, 周海燕. 不穩定骨盆骨折處理的幾個關鍵問題. 中華創傷雜志, 2014, 30(1):12-14.
5.	Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach:a 10-year perspective. J Orthop Trauma, 2006, 20(1 Suppl):S20-29.
6.	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.
7.	張里程, 許猛, 何純清, 等. Kocher-Langenbeck入路治療髖臼橫形骨折伴后壁骨折療效分析. 中國修復重建外科雜志, 2014, 24(12):1428-1431.
8.	White G, Kanakaris NK, Faour O, et al. Quadrilateral plate fractures of the acetabulum:an update. Injury, 2013, 44(2):159-167.
9.	Bible JE, Choxi AA, Kadakia RJ, et al. Quantification of bony pelvic exposure through the modified Stoppa approach. J Orthop Trauma, 2014, 28(6):320-323.
10.	Keel MJ, Ecker TM, Cullmann JL, et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures:an anatomical study and clinical evaluation. J Bone Joint Surg (Br), 2012, 94(5):405-411.
11.	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.
12.	Jeffcoat DM, Carroll EA, Huber FG, et al. Operative treatment of acetabular fractures in an old population through a limited ilioinguinal approach. J Orthop Trauma, 2012, 26(5):284-289.
13.	Briffa N, Pearce R, Hill AM, et al. Outcomes of acetabular fracture fixation with ten years' follow-up. J Bone Joint Surg (Br), 2011, 93(2):229-236.
14.	陳曉東, 崔一民, 沈超, 等. Stoppa入路在治療髖臼骨折中的應用. 中華骨科雜志, 2011, 31(11):1245-1249.
15.	Hirversalo E, Lindahl J, Kiljunen V. Modified and new approaches for pelvic and acetabular surgery. Injury, 2007, 38(4):431-441.
16.	Elmada? M, Güzel Y, Acar MA, et al. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures:a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res, 2014, 100(6):675-680.
17.	Vikmanis A, Vikmanis A, Jakusonoka R, et al. Mid-term outcome of patients with pelvic and acetabular fractures following internal fixation through a modified Stoppa approach. Acta Orthop Belg, 2013, 79(6):660-666.
18.	Khoury A, Weill Y, Mosheiff R. The Stoppa approach for acetabular fracture. Oper Orthop Traumatol, 2012, 24(4-5):439-448.
19.	趙輝, 張軒軒, 張丕軍, 等. 基于CT血管造影三維重建的Corona Mortis動脈解剖學研究及其臨床意義. 中華創傷骨科雜志, 2013, 15(4):303-307.

1. 秦曉東, 李翔, 呂天潤, 等. 改良髂腹股溝下入路治療髖臼骨折的解剖研究和臨床應用. 中國修復重建外科雜志, 2014, 28(1):47-52.
2. Ruan Z, Luo CF, Zeng BF, et al. Percutaneous screw fixation for the acetabular fracture with quadrilateral plate involved by three-dimensional fluoroscopy navigation:surgical technique. Injury, 2012, 43(4):517-521.
3. S.Terry Canale, James H.Beaty. 坎貝爾骨科手術學. 王巖, 唐佩福, 譯. 北京:人民軍醫出版社, 2013:2575-2581.
4. 禹寶慶, 周海燕. 不穩定骨盆骨折處理的幾個關鍵問題. 中華創傷雜志, 2014, 30(1):12-14.
5. Matta JM. Operative treatment of acetabular fractures through the ilioinguinal approach:a 10-year perspective. J Orthop Trauma, 2006, 20(1 Suppl):S20-29.
6. 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.
7. 張里程, 許猛, 何純清, 等. Kocher-Langenbeck入路治療髖臼橫形骨折伴后壁骨折療效分析. 中國修復重建外科雜志, 2014, 24(12):1428-1431.
8. White G, Kanakaris NK, Faour O, et al. Quadrilateral plate fractures of the acetabulum:an update. Injury, 2013, 44(2):159-167.
9. Bible JE, Choxi AA, Kadakia RJ, et al. Quantification of bony pelvic exposure through the modified Stoppa approach. J Orthop Trauma, 2014, 28(6):320-323.
10. Keel MJ, Ecker TM, Cullmann JL, et al. The Pararectus approach for anterior intrapelvic management of acetabular fractures:an anatomical study and clinical evaluation. J Bone Joint Surg (Br), 2012, 94(5):405-411.
11. 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.
12. Jeffcoat DM, Carroll EA, Huber FG, et al. Operative treatment of acetabular fractures in an old population through a limited ilioinguinal approach. J Orthop Trauma, 2012, 26(5):284-289.
13. Briffa N, Pearce R, Hill AM, et al. Outcomes of acetabular fracture fixation with ten years' follow-up. J Bone Joint Surg (Br), 2011, 93(2):229-236.
14. 陳曉東, 崔一民, 沈超, 等. Stoppa入路在治療髖臼骨折中的應用. 中華骨科雜志, 2011, 31(11):1245-1249.
15. Hirversalo E, Lindahl J, Kiljunen V. Modified and new approaches for pelvic and acetabular surgery. Injury, 2007, 38(4):431-441.
16. Elmada? M, Güzel Y, Acar MA, et al. The Stoppa approach versus the ilioinguinal approach for anterior acetabular fractures:a case control study assessing blood loss complications and function outcomes. Orthop Traumatol Surg Res, 2014, 100(6):675-680.
17. Vikmanis A, Vikmanis A, Jakusonoka R, et al. Mid-term outcome of patients with pelvic and acetabular fractures following internal fixation through a modified Stoppa approach. Acta Orthop Belg, 2013, 79(6):660-666.
18. Khoury A, Weill Y, Mosheiff R. The Stoppa approach for acetabular fracture. Oper Orthop Traumatol, 2012, 24(4-5):439-448.
19. 趙輝, 張軒軒, 張丕軍, 等. 基于CT血管造影三維重建的Corona Mortis動脈解剖學研究及其臨床意義. 中華創傷骨科雜志, 2013, 15(4):303-307.

Chinese Journal of Reparative and Reconstructive Surgery

MODIFIED Stoppa APPROACH WITH MEDIAL WALL SPRING PLATE FOR INVOLVING QUADRILATERAL OF ACETABULUM FRACTURE

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