Objectives: 

Review clinical results of the treatment for acetabular fractures using the pararectus approach and analyze surgical variations of the traditional approach.

Design: 

Retrospective.

Setting: 

Tertiary referral hospital.

Patients: 

46 patients over 65 years of age who sustained an acetabular fracture and underwent surgery using the pararectus approach.

Intervention: 

Fractures were treated using a pararectus approach. Three variations of the original technique were performed: (1) Ligature of the deep iliac circumflex artery and vein, (2) separation of the psoas and iliacus muscles, and (3) isolation of the spermatic cord in men and round ligament in women together with the iliac and epigastric vessels.

Main Outcome Measurements: 

Outcomes measures included surgical, demographic, and clinical data, and information related to follow-up.

Results: 

Duration of surgery, 125 minutes (95–210). Quality of reduction on postoperative computed tomography (CT) scan; anatomic in 22 patients (47.8%), incomplete in 16 (34.8%), and poor in 8 (17.4%). In patients in whom the hip was preserved (n = 41), functional status was excellent in 15 patients (36.5%), good in 17 (41.4%), fair in 6 (14.7%), and poor in 3 (7.4%), with mean functional score of 16 points (7–18). Seven patients (15.2%) developed posttraumatic osteoarthritis and 4 of these patients underwent total hip replacement.

Conclusions: 

This study reports positive outcomes in fracture reduction and clinical outcomes with low complications in older patients who suffered acetabular fractures and were treated using a pararectus approach. Small variations in the technique, such as those proposed in this study, may help to widen access to the surgical site and simplify the technique.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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65 岁以上患者髋臼骨折的直肌旁入路。是否有可能改进技术？

目标： 

回顾使用直肌旁入路治疗髋臼骨折的临床结果，并分析传统入路的手术变化。

设计： 

回顾性的。

环境： 

三级转诊医院。

患者： 

46 名 65 岁以上的髋臼骨折患者采用直肌旁入路进行手术。

干涉： 

使用直肌旁入路治疗骨折。对原始技术进行了三种变体：(1) 结扎深旋髂动脉和静脉，(2) 分离腰大肌和髂肌，以及 (3) 将男性的精索和女性的圆韧带一起分离与髂血管和上腹血管。

主要结果测量： 

结果测量包括手术、人口统计和临床数据，以及与随访相关的信息。

结果： 

手术持续时间，125 分钟 (95–210)。术后计算机断层扫描 (CT) 扫描的复位质量；解剖学 22 例 (47.8%)，不完整 16 例 (34.8%)，差 8 例 (17.4%)。在保留髋关节的患者中（n = 41），功能状态优 15 例（36.5%），良好 17 例（41.4%），一般 6 例（14.7%），差 3 例（7.4%） , 平均功能评分为 16 分 (7–18)。7 名患者 (15.2%) 发展为创伤后骨关节炎，其中 4 名患者接受了全髋关节置换术。

结论： 

本研究报告了在髋臼骨折并使用直肌旁入路治疗的老年患者中骨折复位和低并发症临床结果的积极结果。该技术的微小变化，例如本研究中提出的那些变化，可能有助于扩大手术部位的可及性并简化该技术。

证据等级： 

治疗水平 IV。有关证据等级的完整描述，请参阅作者须知。