Traumatology and Orthopedics of RussiaTraumatology and Orthopedics of RussiaТравматология и ортопедия России2311-29052542-0933Vreden National Medical Research Center of Traumatology and Orthopedics174710.17816/2311-2905-1747ReviewsОбзорыReviewsReview ArticleSurgical Approaches for Acetabulum Fracture Treatment: Analytic ReviewХирургические доступы при лечении переломов вертлужной впадины: аналитический обзор литературыhttps://orcid.org/0000-0003-1435-8743KolesnikAlexandr I.КолесникАлександр Иванович
Russian Federation

Dr. Sci. (Med.), Professor

д-р мед. наук, профессор

ko-lesnik@mail.ruhttps://orcid.org/0000-0003-3341-7446DonchenkoSergey V.ДонченкоСергей Викторович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

Don_03@mail.ruhttps://orcid.org/0000-0003-3668-2376SurikovVladislav V.СуриковВладислав Владимирович
Russian Federation
Airbag366@yandex.ruhttps://orcid.org/0000-0002-5821-6774IvanovDmitry A.ИвановДмитрий Александрович
Russian Federation
Ivanovda2001@mail.ruhttps://orcid.org/0000-0002-3960-0148TarasovEvgeniy P.ТарасовЕвгений Петрович
Russian Federation
t.john@mail.ruhttps://orcid.org/0000-0002-4580-5502YarmamedovDmitry M.ЯрмамедовДмитрий Муталифович
Russian Federation
D-yarmamedov@mail.ruhttps://orcid.org/0000-0001-8219-5582SolodilovIvan M.СолодиловИван Михайлович
Russian Federation

Cand. Sci. (Med.)

канд. мед. наук

Ivan_s_007@mail.ruCytoproject LLCООО «ЦИТОпроект»Botkin City Clinical HospitalГБУЗ «Городская клиническая больница им. С.П. Боткина» Департамента здравоохранения г. МосквыRussian Medical Academy of Continuing Postgraduate EducationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииLytkarino City HospitalГБУЗ МО «Лыткаринская городская больница»Odintsovo City HospitalГБУЗ МО «Одинцовская областная больница»Kursk State Medical UniversityФГБОУ ВО «Курский государственный медицинский университет» Минздрава РоссииKursk City Clinical Hospital No. 4ОБУЗ «Курская городская клиническая больница № 4»230920222831061152702202205072022Copyright ©; 2022, Kolesnik A.I., Donchenko S.V., Surikov V.V., Ivanov D.A., Tarasov E.P., Yarmamedov D.M., Solodilov I.M.Copyright ©; 2022, Колесник А.И., Донченко С.В., Суриков В.В., Иванов Д.А., Тарасов Е.П., Ярмамедов Д.М., Солодилов И.М.Copyright ©; 2022, Kolesnik A., Donchenko S., Surikov V., Ivanov D., Tarasov E., Yarmamedov D., Solodilov I.2022Kolesnik A.I., Donchenko S.V., Surikov V.V., Ivanov D.A., Tarasov E.P., Yarmamedov D.M., Solodilov I.M.Колесник А.И., Донченко С.В., Суриков В.В., Иванов Д.А., Тарасов Е.П., Ярмамедов Д.М., Солодилов И.М.Kolesnik A., Donchenko S., Surikov V., Ivanov D., Tarasov E., Yarmamedov D., Solodilov I.https://creativecommons.org/licenses/by/4.0https://journal.rniito.org/jour/article/view/1747

Background. The use of classical and modified surgical approaches to acetabulum is accompanied by serious intra- and postoperative complications associated with tissues, vessels, nerves, and lymphatic structures injury. The choice of approach to acetabulum affects the surgical time and the blood loss volume.

The aim of the review was to compare the surgical time and blood loss volume using different surgical approaches to the acetabulum based on the relevant literature analysis.

Methods. The search was carried out in PubMed/MEDLINE and Scopus databases from 1964 to 2022. When conducting a search for the phrases acetabular fractures, surgical approach to the acetabulum, 4368 articles were found. As a result of the selection, 12 publications containing the most complete information on the studied indicators were included in the quantitative analysis.

Results. The data of surgical treatment of 540 patients with acetabulum fractures were analyzed. The average age of the patients was 45.2±11.6 years. Among the causes of pelvic and acetabulum fractures, road accident (70.4%) and falls from height (21.3%) largely prevailed. The blood loss depended on the use of specific approaches or their combination, and the surgical time. The shortest surgical time (101.0±27.0 min.) was required using pararectal approach, the longest (264±56.4 min.) — with the use of ilio-inguinal approach. The largest volume of blood loss was observed with Pfannenstiel approach — 1057.1±377.9 ml. No statistically significant differences were found when comparing the Kocher-Langenbeck (793±328 ml), ilio-inguinal (828±64 ml) and pararectal (798±322 ml) approach. Performing the Kocher-Langenbeck approach in the patient’s lateral position reduces the surgical time by 16.8% and reduces blood loss by 12.4% compared to the patient’s prone position.

Conclusion. Comparative clinical studies are required to determine the safest surgical approaches to the acetabulum, depending on the type of fracture, the mechanism of injury and the age of the patient.

Актуальность. Применение классических и модифицированных хирургических доступов к вертлужной впадине (ВВ) сопровождается серьезными интра- и послеоперационными осложнениями, связанными с травматизацией тканей, сосудов, нервов, лимфатических структур. Выбор доступа к ВВ влияет на длительность оперативного вмешательства и объем кровопотери.

Цель обзора — на основе анализа литературы сравнить длительность оперативного вмешательства и объем кровопотери при использовании разных хирургических доступов к вертлужной впадине.

Материал и методы. Поиск проводили в базах данных PubMed (MEDLINE) и Scopus с 1964 по 2022 г. При проведении поиска по словосочетаниям acetabular fractures, surgical approach to the acetabulum было найдено 4368 статьи. В результате отбора было включено в анализ 12 публикаций, содержащих наиболее полную информацию по изучаемым показателям.

Результаты. Проанализированы данные оперативного лечения 540 пациентов с переломами ВВ. Средний возраст пациентов составил 45,2±11,6 лет. Среди причин травм таза и ВВ в значительной степени преобладали автодорожная травма (70,4%) и кататравма (21,3%). Объем кровопотери зависел от применения конкретных доступов или их комбинации и продолжительности оперативного вмешательства. Наименьшее количество времени (101,0±27,0 мин.) потребовалось для выполнения операций с использованием параректального доступа, наибольшее (264±56,4 мин.) — с применением подвздошно-пахового доступа. Наибольший объем кровопотери отмечен при доступе Пфанненштиля — 1057,1±377,9 мл. При сравнении доступов Кохера – Лангенбека (793±328 мл), подвздошно-пахового (828±64 мл) и параректального (798±322 мл) доступов не выявлено статистически значимых отличий. Выполнение доступа Кохера – Лангенбека в положении пациента лежа на боку позволяет сократить время операции на 16,8% и сократить объем кровопотери на 12,4% в сравнении с положением пациента лежа на животе.

Заключение. Требуется проведение сравнительных клинических исследований для определения наиболее безопасных хирургических доступов к вертлужной впадине в зависимости от типа перелома, механизма травмы и возраста пациента.

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