临床应用改良Stoppa入路手术治疗髋臼骨折

目的报告改良Stoppa入路手术治疗髋臼骨折的临床效果。方法自2006年1月至2011年1月,应用改良Stoppa入路手术治疗髋臼骨折患者共28例,男17例,女11例;年龄25~52岁,平均36.5岁。损伤后手术时间3~9 d,平均7 d。骨折类型包括:前柱和前壁骨折、横形骨折以及双柱骨折。行耻骨联合上2 cm横行切口,长度约为12cm,从下向上将腹白线纵行切开,进入腹膜外。将腹直肌、髂腰肌、股神经及髂血管等结构向外向前牵开进入骨折部位。结果术后随访2.5~6年,平均4.5年。骨折8~12周愈合(平均10周)。没有发生医源性大血管和神经损伤以及异位骨化。没有出现与该项技术相关的并发症。按Matta等提出的髋臼骨折疗效评定标准评定,优18例,良7例,尚可2例,差1例,优良率为89.28%,取得了满意的效果。结论改良Stoppa入路对治疗髋臼骨折提供了一种新的手术方法,能改善髋臼骨折的复位与固定。

Clinical Application of Operative Treatment of Acetabular Fractures Using a Modified Stoppa Ap-proach

Objective To report clinical results of operative treatment of acetabular fractures using a modified Stoppa ap-proach. Methods From January 2006 to January 2011,28 patients（55 men,31 women）with acetabular fractures were treated using a modified Stoppa approach. They age ranged from 26 to 52 years（mean 36. 5years）. Operative time after injury was from 3 days to 9 days（mean 7 days）. The type of fracture included anterior column or wall fractures,transverse fractures and two column fractures. The approach involves a transverse skin 12 cm incision 2 cm above the pubic symphysis followed by a midline split of the rectus abdominis. Access to the intrapelvic aspect of the pelvis and acetabulum was gained by retraction of the muscular and neurovascular structures. Results Follow-up period ranged from 2. 5 - 6 years（mean 4. 5 years）postopera-tively. All fractures healed 8 - 12 weeks（mean 10 weeks）. There was no heterotopic ossification,major vascular injury and iat-rogenic nerve palsy. There was no apparent complications related to the technique. The recovery rate was calculated with Matta scores. Clinical results were excellent in 18 cases,good in 7,fair in 2,poor in 1. The rates of excellent and good was 89. 28% . Satisfactory clinical results were obtained in this series. Conclusion The modified Stoppa approach offers a new surgical method for fixation of displaced acetabular fractures. The approach offers improved reduction and fixation of acetabular frac-tures.