改良Stoppa入路治疗髋臼骨折

近年来应用改良Stoppa入路治疗髋臼骨折的临床报道逐渐增多。该入路技术能充分显露髋臼内侧壁、四边体、坐骨切迹和骶髂关节,利于该部位骨折复位与固定;较常规手术入路创伤小,可减轻局部组织损伤;易于发现和处理异常的闭孔动脉支（死冠）,减少术中出血,降低常规手术入路并发症,取得了较满意的,临床治疗效果。该文就改良Stoppa入路治疗髋臼骨折研究进展作一综述。     

改良Stoppa入路与髂腹股沟入路内固定治疗骨盆骨折的疗效观察

目的 探究改良Stoppa入路与髂腹股沟入路内固定治疗骨盆骨折的效果。方法 回顾性选取2018年1月至2021年2月接受治疗的骨盆骨折患者105例,根据其手术入路进行分组,其中51例采用改良Stoppa入路的患者为改良Stoppa组,54例采用髂腹股沟入路的患者为髂腹股沟组。记录所有患者手术相关参数（切口长度、手术暴露时间、术中出血量等）及住院时间。采用Merle d’Aubigne-Postel评分标准评估患者髋关节功能。统计不良反应发生情况,并计算术后并发症总发生率。自拟“骨盆骨折手术满意度调查问卷”进行患者满意度评分。结果 改良Stoppa组患者手术切口长度、手术暴露时间、住院时间均短于髂腹股沟组,术中出血量少于髂腹股沟组（P<0.05）。出院、末次随访时,改良Stoppa组患者Merle d’Aubigne-Postel评分高于髂腹股沟组（P<0.05）。改良Stoppa组不良事件总发生率为3.92%,髂腹股沟组为16.67%,差异有统计学意义（P<0.05）。改良Stoppa组患者住院时间、住院费用、就诊体验、伤口疼痛程度评分均显著高于髂腹股沟组（P<...     

改良Stoppa入路切开复位内固定治疗髋臼骨折

目的探讨采用改良Stoppa入路切开复位内固定治疗髋臼骨折的疗效。方法对41例髋臼骨折患者采用改良Stoppa入路行切开复位内固定治疗。结果手术时间95~210(168.1±79.8)min,出血量550~1 500(646.3±187.5)ml。骨折解剖复位率82.9%(34/41)。41例均获得随访,时间12~58(41.9±11.8)个月。改良Merle d'Aubigne-Postel评分14~19(17.1±1.3)分,其中优31例,良8例,可2例,优良率95.1%。结论采用改良Stoppa入路切开复位内固定治疗髋臼骨折,临床功能满意,具有手术时间短、出血量少、解剖复位率高、并发症发生率低等优势。     

改良Stoppa入路联合髂嵴前入路及K-L入路治疗复杂髋臼骨折合并骨盆骨折

[目的]探讨应用改良Stoppa联合髂嵴前入路及Kocher-Langenbeck三种手术入路联合治疗髋臼骨折合并骨盆环骨折的临床疗效。[方法]2013年6月~2014年7月,采用改良Stoppa入路联合髂嵴前入路重建钛板固定髋臼前柱及前壁骨折结合K-L入路固定髋臼后壁及后柱技术,治疗10例骨盆骨折患者,男7例,女3例;年龄31~60岁,平均42.8岁。髋臼骨折按照Judet分型:分为T型骨折、双柱骨折。采用Matta评估标准评定骨折复位情况,采用Matta评分标准评定术后功能情况。[结果]10例患者均获随访,时间4~13个月,平均7.3个月。手术时间80~140 min,平均100 min。术中出血量500~900 ml,平均780 ml。骨折愈合时间为12~16周,平均14周。骨折复位按照Matta评估标准:解剖复位6例,满意复位4例。术后功能评定按Matta评分标准:优7例,良2例,可1例。[结论]应用改良Stoppa联合髂嵴前入路及K-L入路治疗复杂髋臼骨折合并骨盆骨折,可以充分利用每种切口的优势,具有相对减少创伤、手术操作安全、并发症少、复位容易、固定牢靠、可早期活动的优点,是一种比较理想的手术方法。     

改良Stoppa入路治疗不稳定型骨盆骨折

目的探讨不稳定型骨盆骨折手术治疗方法。方法对11例不稳定型骨盆骨折采用改良Stoppa入路重建钢板内固定,并进行随访。结果 11例平均随访15个月,所有患者骨折均愈合,能不扶拐站立行走,且步态正常。结论改良Stoppa入路治疗不稳定型骨盆骨折,能够重建骨盆的稳定性,减少手术创伤,缩短手术时间,有利于患者早期恢复,减少并发症的发生。     

Stoppa入路的临床解剖学研究及在骨盆前环骨折中的应用

目的 探讨Stoppa入路的解剖要点及在骨盆前环骨折中的应用. 方法 通过20具(40侧)教学尸体标本观察Corona mortis血管的出现率.通过骨盆正位X线片测量钢板在骨盆内侧壁进钉的安全区.回顾性分析2009年4月至2012年12月收治的22例骨盆前环骨折患者资料,男14例,女8例;平均年龄为32.6岁(17 ～56岁).单纯前环骨折16例,伴骶髂关节骨折脱位6例.骨折按Tile分型:A2型3例;B2型6例,B3型7例;C2型4例,C3型2例.均采用Stoppa入路手术治疗. 结果 尸体标本观察Corona mortis血管的出现率为85.0％ (34/40).在真骨盆内侧缘,耻骨支区4孔钢板长度和邻近骶髂关节区3～4孔钢板长度进钉是安全的,髋臼区不能进钉.18例(81.8％)患者术中发现Corona mortis血管,均予以结扎.术后骨折复位质量根据Matta标准评定:解剖复位14例,良好复位7例,复位差1例,复位优良率为95.4％.19例患者术后获6～12个月(平均10.4个月)随访.19例患者骨折愈合时间为2～4个月,平均2.8个月.末次随访时骨盆功能按照Majeed评分标准评定:优12例,良5例,可2例. 结论 解剖标本和临床观察Corona mortis血管的出现率均较高.应用Stoppa入路治疗骨盆前环骨折时能清晰地显示并方便处理Corona mortis血管,临床疗效良好.     

改良Stoppa入路手术治疗不稳定骨盆骨折合并髋臼骨折效果分析

目的探讨不稳定骨盆骨折合并髋臼骨折的手术入路方法及其疗效。方法选取2010-06—2015-06间收治的76例不稳定骨盆骨折合并髋臼骨折患者,随机分成2组。对照组给予传统髂腹股沟入路,观察组行改良Stoppa入路。比较2组手术时间、术中出血量、骨折复位效果、髋关节功能及安全性。结果与对照组比较,观察组手术时间较短,术中出血量和术后引流量较少,术后骨折愈合时间缩短(P0.05)。观察组的骨折复位优良率、髋关节功能优良率及术后并发症发生率均明显优于对照组(P0.05)。结论采用改良Stoppa入路治疗不稳定骨盆骨折合并髋臼骨折,可有效缩短手术时间,减少术中出血量,缩短术后骨折愈合时间,骨折复位良好,安全可靠。     

应用改良Stoppa入路手术治疗骨盆髋臼骨折的疗效分析

目的探讨应用改良Stoppa入路手术治疗骨盆、髋臼骨折的手术方法及疗效。方法笔者回顾分析自2010-01—2014-12应用改良Stoppa入路手术治疗的48例骨盆、髋臼骨折的临床资料,其中骨盆骨折34例,髋臼骨折14例。结果所有患者获随访6个月~5年,平均24个月。本组手术切口长度(9.2±2.7)cm,手术时间(1.7±0.7)h,出血量(545±230)ml。术后X线片示骨折复位满意,末次随访时疗效根据Matta功能评分标准评定:优36例,良10例,可2例,优良率95.8%。1例术中发生膀胱破裂,1例术后发生深静脉血栓,无切口感染、骨折不愈合、股外侧皮神经麻痹、腹股沟疝及医源性血管神经损伤等并发症发生。结论改良Stoppa入路手术治疗骨盆髋臼骨折具有操作安全、创伤小、视野清晰、骨折易于复位及固定、疗效可靠、并发症少等优点,具有一定的临床应用价值。     

改良Stoppa入路联合髂棘入路髋臼周围截骨术

[目的]介绍改良Stoppa入路联合髂棘入路行髋臼周围截骨术的手术技术.[方法]手术治疗2018-2019年本科收治的成人发育性髋关节发育不良患者共3例,1例单髋,2例双髋.术前3D打印骨盆及双髋关节,并测量LCE角、ACE角及Tonnis角.取腹正中Stoppa切口,显露腹直肌鞘,沿腹白线分开腹直肌,沿腹膜外间隙暴露...     

改良Stoppa入路与髂腹股沟入路治疗骨盆髋臼骨折的疗效比较

[目的]比较改良Stoppa切口入路与髂腹股沟入路治疗骨盆髋臼骨折的临床疗效。[方法]选取本院骨科2011年1月~2015年1月收治的合并骨盆骨折的髋臼骨折患者80例,均行切开复位内固定术。根据手术入路不同分为Stoppa入路组和髂腹股沟入路组各40例,回顾性分析患者的临床资料,比较两组患者的切口长度、手术显露时间、术中出血量、术后住院时间、术后并发症情况、术后3 d骨折复位质量以及髋关节功能评分。[结果]两组患者手术显露时间差异无统计学意义(P>0.05),Stoppa入路组切口长度和术中出血量均低于髂腹股沟入路组,差异有统计学意义(P<0.05)。两组患者术后住院时间及术后3 d Matta影像学评分优良率差异均无统计学意义(P>0.05)。Stoppa入路组术后并发症发生率为10.00%,髂腹股沟入路组为27.50%,差异有统计学意义(P<0.05)。与术前相比,两组患者术后髋关节功能评分均有所提高(P<0.05),出院时及末次随访时两组患者评分差异无统计学意义(P>0.05)。[结论]对于合并骨盆骨折的复杂髋臼骨折,改良Stoppa入路与髂腹股沟入路均效果显著,但前者手术暴露简单,对组织损伤小,术中出血量少,并发症发生率低,符合现代骨科手术微创的理念。     

Treatment results for acetabulum fractures using the modified Stoppa approach

Objectives

The aim of this study was to evaluate the clinical and radiological results of the surgical treatment of acetabular fractures using modified Stoppa approach.

Corona Mortis血管解剖学研究及其临床意义

目的:探讨闭孔血管和髂外血管在腹股沟区的分支,为减少髂腹股沟入路术中出血提供解剖学基础。方法:对25具新鲜中国成人尸体标本共50侧半骨盆进行解剖学研究,观测闭孔血管和髂外血管在腹股沟区的分支及其吻合支(CoronaMortis血管)的大小、出现率、吻合血管行径和吻合血管至耻骨联合的距离。结果:72%(36侧)耻骨上支表面至少存在1条血管吻合支,其中28%(14侧)存在2条或3条血管吻合支,24%(12侧)同时存在动脉吻合支和静脉吻合支。耻骨上支表面的血管吻合支平均直径2.6mm(2.0～4.2mm)。血管吻合支紧贴耻骨上支或髂耻隆起,几乎垂直地下行于髋臼窝壁或耻骨支后方,经闭膜管出盆腔,血管吻合支与耻骨联合的平均距离52mm(38～68mm)。在此区域手术以及髋臼或骨盆前环骨折极易损伤CoronaMortis血管。结论:闭孔血管和髂外血管的吻合支较粗,出现率高,位于耻骨上支表面。髂腹股沟手术入路应特别注意CoronaMortis血管的存在。     

Surgical exposures and options for instrumentation in acetabular fracture fixation: Pararectus approach versus the modified Stoppa

BackgroundAs an alternative to the modified Stoppa approach, the Pararectus approach is used clinically for treatment of acetabular fractures involving the anterior column. The current study assessed the surgical exposure and the options for instrumentation using both of these approaches.MethodsSurgical dissections were conducted on five human cadavers (all male, mean age 88 years (82–97)) using the modified Stoppa and the Pararectus approach, with the same skin incision length (10 cm). Distal boundaries of the exposed bony surfaces were marked using a chisel. After removal of all soft-tissues, distances from the boundaries in the false and true pelvis were measured with reference to the pelvic brim. The exposed bone was coloured and calibrated digital images of each inner hemipelvis were taken. The amount of exposed surface using both approaches was assessed and represented as a percentage of the total bony surface of each hemipelvis. For instrumentation, a suprapectineal quadrilateral buttress plate was used. Screw lengths were documented, and three-dimensional CT reconstructions were performed to assess screw trajectories qualitatively. Wilcoxon's signed rank test for paired groups was used (level of significance: p < 0.05).ResultsAfter utilization of the Pararectus approach, the distances from the farthest boundaries of exposed bone towards the pelvic brim were significantly higher in the false but not the true pelvis, compared to the modified Stoppa approach. The percentage (mean ± SD) of exposed bone accessible after utilizing the Pararectus approach was 42 ± 8%, compared to 29 ± 6% using the modified Stoppa (p = 0.011). In cadavers exposed by the Pararectus approach, screws placed for posterior fixation and as a posterior column screw were longer by factor 1.8 and 2.1, respectively (p < 0.05), and screws could be placed more posteromedial towards the posterior inferior iliac spine or in line with the posterior column directed towards the ischial tuberosity.ConclusionCompared to the modified Stoppa, the Pararectus approach facilitates a greater surgical access in the false pelvis, provides versatility for fracture fixation in the posterior pelvic ring and allows for the option to extend the approach without a new incision.     

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

BackgroundAs the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures.MethodsTwenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d’Aubigne and Postel score with a mean follow up of 15.13 months.ResultsThe clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively.ConclusionsMinimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.     

Short-term results of surgical treatment of acetabular fractures using the modified Stoppa approach

BackgroundAs the more commonly used ilioinguinal approach is extensive and associated with complications arising from the dissection along the inguinal canal, we attempt to evaluate the efficacy of the modified Stoppa approach as an alternative in the operative management of acetabular fractures.MethodsTwenty-three patients with acetabular fractures, were operated by the modified Stoppa approach. Fractures were classified; operative time and blood loss were recorded; the radiological and clinical outcomes were prospectively analysed. We analysed the radiological results according to the criteria of Matta and the clinical results by the Merle d’Aubigne and Postel score with a mean follow up of 15.13 months.ResultsThe clinical outcomes were excellent or good in nineteen cases, fair and poor in two patients each. In eighteen of our cases the reduction was anatomic, imperfect in two cases, and poor in three cases. The mean pre-operative displacements on axial, sagittal and coronal NCCT sections were 3.8, 3.1 and 3.6 mm, respectively; and mean post-operative displacements were 0.2, 0.3 and 0.2 mm, respectively. The mean pre-operative and post-operative fracture gap were 12.8 mm and 1.1 mm respectively.ConclusionsMinimizing perioperative morbidity and simultaneously allowing access for anatomical reduction are the major benefits of the approach. The modified Stoppa approach can substitute the ilioinguinal approach for the surgical fixation of acetabular fractures.     

Modified Stoppa Approach for Surgical Treatment of Acetabular Fracture

BackgroundWe analyzed the extent of the comminution in the acetabular weight-bearing area, the clinical and radiographic results, and the complications after a minimum 2-year follow-up of the modified Stoppa approach for the treatment of acetabular fractures, and we attempted to evaluate the efficacy of the operative technique.MethodsAll of the 22 patients, who needed the anterior approach for the treatment of acetabular fractures at our hospital from November 2007 to November 2010, were subjected to surgery via the modified Stoppa approach. Fracture pattern, operative time, blood loss during the operation, quality of reduction, number of bony fragments in the acetabular weight-bearing area, and postoperative complications were assessed by retrospectively analyzing the medical records and the radiographic examinations. The results after the operation were analyzed based on the criteria of Matta.ResultsThe clinical results were excellent in 3 cases, good in 13 cases, and poor in 4 cases, while the radiographic results were excellent in 5 cases, good in 13 cases, and poor in 2 cases. Although the quality of reduction and the clinical results according to the extent of comminution were statistically significant (p = 0.03 and p = 0.04, respectively), the radiographic results were not statistically significant (p = 0.74).ConclusionsIt can be concluded that the modified Stoppa approach could be used as an alternative to the classic ilioinguinal approach. In addition, comminution of the acetabular fracture was an important factor causing non-anatomic reduction and finally unsatisfactory clinical results.     

重组核因子κB活化因子受体蛋白预防小鼠骨质疏松的研究

目的:探讨Stoppa入路结合后方经皮钢板技术治疗C型骨盆骨折的临床疗效.方法:2009年6月至2011年7月,采用Stoppa入路重建钢板固定骨盆前环骨折结合后方经皮重建锁定钢板固定骨盆后环骨折的技术治疗16例C型骨盆骨折患者,男11例,女5例;年龄22～59岁,平均38.8岁.按照Tile分型:C1型10例,C2型4例,C3型2例.采用Tometta评估标准评定骨折复位情况,采用Majeed评分标准评定术后功能情况.结果:16例患者均获随访,时间4～13个月,平均7.3个月.手术时间80～140 min,平均100 min.术中出血量200～500 ml,平均280 ml.骨盆骨折的愈合时间为12～16周,平均14周.骨折复位按照Tometta评估标准:优9例,良6例,可1例.术后功能评定按Majeed评分标准:优9例,良5例,可2例.结论:Stoppa入路重建钢板固定骨盆前环骨折结合后方经皮重建锁定钢板固定骨盆后环骨折技术治疗C型骨盆骨折具有创伤小、手术操作安全、并发症少、固定牢靠、可早期活动的优点,是一种比较理想的微创手术方法.     

Stoppa入路治疗骨盆、髋臼骨折的疗效

目的探讨应用Stoppa手术入路治疗骨盆、髋臼骨折的疗效。方法采用Stoppa入路切开复位内固定治疗20例骨盆、髋臼骨折患者,其中骨盆骨折12例,髋臼骨折8例。12例骨盆骨折中使用Stoppa入路8例,Stoppa入路联合髂窝入路4例;8例髋臼骨折中使用Stoppa入路4例,Stoppa入路联合K-L入路2例,联合髂窝入路2例。结果 20例均获得随访,时间12~36个月。骨折均愈合。术后根据Matta影像学评分:12例骨盆骨折复位均为优,髋臼骨折复位优6例、良2例。依据改良的Merle d'Aubigne-Postel髋关节评分标准评价疗效:优18例,良2例。结论 Stoppa入路治疗骨盆、髋臼骨折可以获得良好的放射学及临床结果,对骨盆高位耻骨支骨折及髋臼四边体骨折的治疗具有优越性。