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摘要
Objective: To compare the clinical efficacy between direct posterior approach (DPA) and Kocher-Langenbeck(K-L) approach in the treatment of posterior acetabular fractures. Methods: From January 2012 to June 2018, 45 posterior acetabular fractures were treated at Department of Orthopaedics, The Third Affiliated Hospital to Southern Medical University. According to the surgical approaches, they were divided into 2 groups. Group A (21 cases) was treated via DPA approach, including 17 males and 4 females with an age of 42.2 years ± 14.7 years; group B (24 cases) was treated via conventional K-L approach, including 21 males and 3 females with an age of 42.8 years ± 11.9 years. The 2 groups were compared in terms of operation time, intraoperative blood loss, incision length, fracture union time, fracture reduction quality, postoperative complications and hip function at the last follow-up. Results: There was no significant difference in the preoperative general data between the 2 groups, showing comparability (P>0.05). Group A had significantly shorter operation time (60.0 min ± 15.7 min), significantly shorter incision length (9.6 cm ± 1.1 cm) and significantly less intraoperative blood loss (325.7 mL ± 79.9 mL) than group B (115.2 min ± 42.4 min, 17.6 cm ± 2.3 cm and 404.2 mL ± 147.4 mL, respectively) (P<0.05). All the 45 patients were followed up for 12 to 37 months (mean, 19.2 months). There were no significant differences between the 2 groups in postoperative quality of reduction, fracture union time or postoperative complications (P>0.05).The functional recovery of the affected hip by the modified Merle d'Aubigne-Postel scoring system at the last follow-up was rated as excellent in 14 cases, good in 5 and fair in 2, giving an overall excellent and good rate of 90.5%(19/21) in group A while as excellent in 12 cases, good in 3, fair in 6 and poor in 3, giving an excellent and good rate of 62.5%(15/24) in group B, showing a significant difference between the 2 groups (P<0.05). Conclusions: In the treatment of posterior acetabular fractures, the direct posterior approach is safe and effective because it is advantageous over the conventional K-L approach in operation time, intraoperative blood loss, surgical invasion and postoperative recovery.
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