Modified Kloen Approach Treatment For Acetabular Ractures
Objective: This study is to evaluate the feasibility and efficacy of modified Kloen approach for the treatment of acetabular fractures through lateral window exposure beneath fascia iliaca with superior ramus of pubis exposure by internal small incision. Method There were 42 patients of patients suffering acetabular fractures adopted modified Kloen approach treatment in The First Affiliated Hospital of Zhengzhou University from January 2012 to December 2014. In total, there were 26 male and 16 female, with age ranging 15 - 60 years old, mean age of 34.5 years old. The acetabular fractures were classified based on Judet-Letournel, following as, 1 case of anterior wall fractures, 18 cases of anterior column fractures, 15 cases of transverse fractures, 3 cases of T-shape fractures and 5 cases of both-column fractures. In total, 34 cases received the treatment of single modified Kloen approach and 8 cases for combined Kocher-Langenbeck approach. Matta radiologicalcriteria was employed to evaluate the post operation recovery, and modified D’Aubigne-Postel evaluation system was adopted for demonstration of hip joint function condition. Results The mean surgical time was 110 minutes (90 - 210 minutes); the mean blood loss was 530ml(400-1050ml). There is noincision infection, neurovascular traumaor postoperative lymphorrhagia.42 patients cooperated with the following up of 11.2 months (6-21 months). The average bone healing time was 13 weeks (13-20 weeks). Matta radiological criteria was to evaluate the postoperative fracture quality, 18 case with excellent recovery, 16 cases with good recovery, 4 cases with normal recovery and 1 case with bad recovery. Modified D’Aubigne-Postel evaluation was taken 6 months after surgery, 17 cases with excellent recovery, 22 cases with good recovery, 2 cases with normal recovery and 1 case with bad recovery. There was no internal fixation loosening, breakage or inguinal hernia, while, 1 case for osteonecrosis of the femeral head and traumatic osteoarthritis was given the treatment of total hip replacement arthroplasty. Conclusion Themodified Kloen approach was anatomically clear, easy to master, and improve iliofemoral vascular activity, expense exposure range for restoration and fixation, reduce neurovascular and lymphoid complications. Besides, the exposure of articular surface could ensure the condition of restoration quality, and the little incision beneath the lacunar ligament could prevent the extensive destruction of canalis inguinalis and myopectineal orifice area, and avoid the incidence of postoperative hernia. The rehabilitation exercise contributed to the recovery of joint function.