Stoppa入路在髋臼骨折中的应用

Applying Stoppa approach in acetabular fractures

目的探讨Stoppa入路治疗髋臼骨折的手术方法及初步临床效果。方法2005年5月至2010年5月，应用Stoppa入路治疗髋臼骨折23例，男17例，女6例；年龄21-71岁，平均37岁；车祸伤14例，坠落伤7例，跌倒摔伤2例。髋臼骨折按Letoumel分型：前柱骨折7例，前柱加后半横行骨折6例，横行骨折6例，双柱骨折4例。患者均采用Stoppa入路手术，4例双柱骨折及4例前柱加后半横行骨折患者附加外侧切口。结果23例患者手术时间为110-320min，平均166min；术中失血量为300-2500ml，平均647ml；输红细胞0-12个单位，平均3．3个单位。术后3个月所有骨折均愈合。所有患者均获得随访，随访时间12-36个月，平均20个月。依据Matta髋臼骨折复位标准，优15例（65％），良5例（22％），差3例（13％）；优良率为87％。根据Matta改良的Merled’Aubigne和Postel髋关节功能评分标准，优11例（48％），良7例（30％），可3例（13％），差2例（9％）；优良率为78％。术后1例患者发生伤口浅表感染，经清创后愈合；1例因牵拉闭孔神经致股内收肌肌力下降，1年后恢复至4级。末次随访时，无一例发生坐骨神经、股神经以及主要血管损伤，亦未出现与切口相关的其他并发症。结论对于具有适应证的髋臼骨折患者，Stoppa入路不但可以获得满意的显露，而且便于骨折复位和内固定，特别是对伴股骨头中心性脱位及髋臼内壁内移明显者具有一定的优势。

Objective To report the preliminary results and surgical technique of Stoppa approach used in treatment of acetabular fracture. Methods From May 2005 to May 2010, 23 patients with acetabular fracture were treated using modified Stoppa approach. The mean age was 37 years old （range, 21-71 years old）. According to Letournel classification, there were 7 cases in anterior column fracture, 6 cases in anterior column with posterior hemitransverse fracture, 6 cases in transverse fracture, 4 cases in associated with both column fractures. All patients in the study were operated under general anesthesia on a radiolucent table in a supine position and underwent Stoppa approach. Fracture reduction was evaluated by Matta＇s score system. The clinical outcome was judged by modified Merle d＇ Aubigne and Postel score system. Four cases of associated both column fractures, 4 cases of anterior column with posterior hemitransverse fracture required the use of the lateral window. Results The mean surgical time was 166 min （range, 110-320 min）. The mean blood lose was 647 ml （range, 300-2500 ml）. Blood transfusion was 3.3 unites （0-12 unites）. All the factures healed in 3 months. The fracture reduction was evaluated according to the Matta＇s score system： an excellent reduction was obtained in 15 patients（65%）, a good reduction was obtained in 5 patients （22%）, and three （13%） were considered poor. Clinical results were excellent in 11 patients （48%）, good in 7 pa- tients （30%）, fair in 3 patient （13%）, and poor in 2 patients （9%）. Superficial wound infection happened in 1 case. It healed after debridment. One patient noted to have significant weakness of the hip adductors （obturator nerve palsy） after surgery. It reached grade IV one year later. No sciatic nerve, femoral nerve and vascular injury happened in this study. Conclusion For the selected acetabualar fracture, Stoppa approach can get satisfied exposure and fixation of the fracture, especially in the patient with central dislocation of the femoral head as well as medial displacement of quadrilateral plate.