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Ventrale Zugänge zum Azetabulum

Ventral approaches to the acetabulum

  • Leitthema
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Die Wahl eines suffizienten Zuganges ist von immanenter Wichtigkeit, um eine qualitativ hochwertige Reposition zu erreichen und alle Frakturkomponenten sicher zu stabilisieren. Der extrapelvine ilioinguinale Zugang gilt dabei als Goldstandard zur operativen Versorgung von Azetabulumfrakturen. Aufgrund des demografischen Wandels mit veränderten Frakturmustern gewinnen jedoch die intrapelvinen Zugänge zunehmend an Bedeutung. Aktuelle Daten zeigen, dass diese diverse Vorteile in der operativen Stabilisierung ventraler Pathologien innehaben. Analog zum modifizierten Stoppa-Zugang bietet der wenig invasive und weichteilschonende Pararektus-Zugang den Vorteil der direkten Visualisierung intrapelviner Strukturen und erlaubt gleichermaßen die Exposition, die durch den ilioinguinalen Zugang erreicht werden kann. Eine detaillierte präoperative Auseinandersetzung mit der Fraktur und die stringente präoperative Planung bestimmen jedoch letztendlich die Wahl des notwendigen Zuganges und sind damit wegbereitend für ein gutes klinisches Ergebnis.

Abstract

The choice of an appropriate surgical approach is of utmost importance to achieve anatomic reduction and secure fixation and stabilization of all fracture components. To date, the extrapelvic ilioinguinal approach is considered as the gold standard in the surgical treatment of acetabular fractures; however, based on the demographic change and the accompanying alterations in fracture patterns, intrapelvic approaches including the modified Stoppa approach and the pararectal approach are gaining increasing interest and clinical significance. Current data demonstrate several advantages of intrapelvic approaches to address ventral pathologies of the acetabulum. Similar to the modified Stoppa approach, the less invasive pararectal approach enables direct visualization of intrapelvic structures and furthermore a degree of exposure comparable to the ilioinguinal approach; however, a detailed preoperative study of the fracture and vigorous preoperative planning ultimately determine the appropriate approach and are the cutting edge for a good clinical outcome.

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    S. Märdian, V. Lembke, D. Rau & J. Keller

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  1. S. Märdian
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  2. V. Lembke
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Correspondence to S. Märdian.

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S. Märdian, V. Lembke, D. Rau und J. Keller geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Märdian, S., Lembke, V., Rau, D. et al. Ventrale Zugänge zum Azetabulum. Trauma Berufskrankh 19, 127–135 (2017). https://doi.org/10.1007/s10039-017-0278-2

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