改良Stoppa入路在骨盆髋臼骨折治疗中的初步应用

目的 探讨改良Stoppa入路在骨盆髋臼骨折治疗中的应用疗效.方法 2008年3月至2009年12月共收治26例骨盆骨折和9例髓臼骨折患者,男28例,女7例;年龄18～61岁,平均37岁.26例骨盆骨折按Tile分型:B1型2例,B2型4例,B3型7例;C1-1型4例,C1-2型2例,C1-3型4例,C2型3例.9例髋臼骨折按Letournel分型:前柱骨折1例,横形骨折3例,T形骨折2例,前柱伴后半横形骨折1例,双柱骨折2例.26例骨盆骨折中单独使用改良Stoppa入路10例,联合髂窝入路15例,联合后路1例.9例髋臼骨折中单独使用改良Stoppa入路3例,联合Kocher-Langenbeck入路4例,联合髂窝入路及Kocher-Langenbeck入路2例.结果 除1例患者外,其余34例患者的平均手术时间为90 min(65～135min),平均出血量为320 mL(150～1200 mL).术后根据Matta影像学评分,骨盆骨折前后环损伤均复位优;髋臼骨折解剖复位8例,满意复位1例.4例骨盆骨折患者失访,其余22例患者平均随访4个月,钢板断裂及螺钉松动各1例.2例髋臼骨折患者失访,其余7例患者获平均4个月随访,1例屈髋轻度受限,1例BrookerⅡ型异位骨化,无股骨头坏死.29例获随访患者骨折均获愈合,平均愈合时间为2.7个月(2.5～4.0个月).结论 改良Stoppa入路可单独或联合其他入路治疗骨盆髋臼骨折,其具有操作便捷、并发症少的优点.

Modified Stoppa approach in treatment of pelvic and acetabular fractures

Objective To evaluate the modified Stoppa approach in treatment of patients with pelvic and acetabular fractures. Methods We analyzed the outcomes of 26 consecutive patients with fractures of the pelvic ring and 9 patients with acetabular fractures who had been treated between March 2008 and December 2009 by open reduction and internal fixation through the modified Stoppa approach. The modified Stoppa approach was made through a low midline incision to fix the pelvis and acetabular fractures. By Tile classification, the 26 pelvic fractures included 2 cases of B1, 4 of B2, 7 of B3, 4 of C1-1, 2 of C1-2, 4 of C1-3, and 3 of C2. By Letournel classification, the 9 acetabular fractures included one case of anterior column, 3 transverse cases, 2 T type cases, one anterior column plus posterior transverse case, and 2 cases of both columns. For pelvic fractures, the modified Stoppa approach was used exclusively in 10 cases, in combination with the iliac fossa approach in 15 cases, and in combination with the posterior approach in one case. For acetabular fractures, the modified Stoppa approach was used exclusively in 3 cases, in combination with the Kocher-Langenbeck approach in 4 cases, and in combination with the Kocher-Langenbeck and iliac fossa approaches in 2 cases of both columns. Results The average operation time was 90 min (65 to 135 min)and the blood loss averaged 320 mL(150 to 1200 mL) in all but one patient with obsolete fracture of both columns. The reductions of the pelvic and acetabular fractures were all excellent and good. Twenty-two patients with pelvic fracture were accessible for an average follow-up of 4 months. Among them, one case of plate breakage and one case of screw loosening were found. Seven patients with acetabular fracture were accessible for an average follow-up of 4 months. One case of mild hip flexion and one case of ectopic ossification were found in them but there was no femoral head necrosis. Satisfactory functional results were achieved in the 29 cases that had been followed up. Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat pelvic and acetabular fractures effectively, providing advantages of easy manipulation and a low complication rate.