[Analysis of result and influence factors of operative treatment of acetabular fractures].

OBJECTIVE: To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors.

METHODS: The clinical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009. Of 82 patients, 65 were male and 17 were female, aged 26-72 years (mean, 38 years). Fractures were caused by traffic accident in 62 cases, by crush in 13 cases, and by falling from height in 7 cases. The time from injury to admission was 30 minutes to 12 days (median, 7.6 hours) in 70 cases, 12 cases were transferred because poor result after 34-67 days of conservative treatment. According to Judet classification, there were 24 cases of posterior wall fracture, 3 cases of posterior column fracture, 1 case of anterior wall fracture, 2 cases of anterior column fracture, 6 cases of transverse fracture, 16 cases of transverse and posterior wall fracture, 4 cases of posterior column and posterior wall fracture, 5 cases of T-type fracture, 3 cases of anterior and posterior hemitransverse fracture, and 18 cases of complete both-column fracture; 24 cases combined with dislocation of the hip. During operation, Kocher-Langenbeck approach was used in 49 cases, anterior ilioinguinal approach in 19 cases, and the combination of anterior and posterior approaches in 14 cases. Reconstructive plate (74 cases) and hollow lag screw (8 cases) internal fixation were used. The function of the hip was evaluated according to the modified Merled'Aubigne-Postel hip score system postoperatively. According to fracture type, age, lower extremity fracture before operation, quality of reduction, timing of surgery, hip dislocation and time of reduction, operative approach, deep vein thrombosis (DVT), and heterotopic ossification (HO), the patients were divided into the groups and the results were compared.

RESULTS: Accordance with the Matta X-ray evaluation criteria, anatomic reduction was achieved in 21 cases, good reduction in 37 cases, fair reduction in 16 cases, and poor reduction in 8 cases, and the excellent and good rate was 71%. All the cases were followed up 12-52 months (mean, 34 months). Iatrogenic sciatic nerve injury occurred in 8 cases, infection in 3 cases, HO in 16 cases, DVT in 3 cases, hip posttraumatic arthritis in 12 cases, and avascular necrosis of the femoral head in 9 cases. X-ray examination showed that 80 cases achieved fracture union at 10-24 weeks after operation (mean, 14 weeks) and 2 cases had fracture delayed union at 10 months and 12 months after operation. According to the modified Merled'Aubigne-Postel hip score system, the function of the hip was rated as excellent in 26 cases, good in 32, fair in 20, and poor in 4 at 6 months after operation; the excellent and good rate was 71%. The affecting factors of clinical results of acetabular fractures were fracture type, age, lower extremity fracture before operation, quality of reduction, timing of surgery, hip dislocation and time of reduction (P < 0.05). However the operative approach, DVT, and HO were not affecting factor of the acetabular fractures (P > 0.05).

CONCLUSION: Operative treatment of acetabular fractures has a satisfying therapeutic effect. Fracture type, age, lower extremity fracture before operation, quality of reduction, timing of surgery, hip dislocation, and time of reduction are risk factors affecting postoperative results.