采用下腹正中切口手术治疗骨盆前环复杂骨折

Application of Stoppa intrapelvic approach for the treatment of complicated fractures of anterior pelvic ring

目的探讨采用下腹正中切口(Stoppa入路)手术在治疗骨盆前环复杂骨折中的临床经验与治疗效果。方法对2008年2月～2009年5月应用Stoppa入路治疗的11例骨盆前环复杂骨折患者临床资料进行总结。按照Tile分类:B2型6例,B3型3例,C2型2例。手术采用Stoppa入路,其中4例采用前环钢板固定,4例采用前环钢板和外固定器固定,3例采用前环钢板和骶髂螺钉固定。结果 Stoppa入路平均切口长度12cm(10～14cm),平均手术时间100min(80～120min),平均出血500ml(300～800ml)。11例前环损伤均复位满意,无手术并发症。9例术后获得8～10个月随访,均获骨性愈合。结论 Stoppa入路具有操作简单、解剖清晰、切口小、并发症少、恢复快的特点。在治疗骨盆前环复杂骨折时,Stoppa入路是非常合适的选择。

Objective To investigate the clinical experience and effects of adopting the Stoppa approach in the treatment of complicated fractures of anterior pelvic ring. Methods From Feb. 2008 to May 2009,11 cases of complicated fractures of anterior pelvic ring were treated through the Stoppa approach. According to the Tile classification ,6 cases were Tile type B2,3 cases were B3 and 2 cases were C2. The Stoppa approach was adopted for operation,including anterior plate fixation in 4 cases,anterior plate fixation and external fixator in 4 cases,fixation with anterior plate and sacroiliac screws in 3 cases. Results The average incision length of the Stoppa approach was 12 cm（ range from 10 to 14 cm） ,the mean operation time and blood loss were 100 min（ range from 80 to 120 rain） and 500 ml（range from 300 to 800 ml） respectively. All cases obtained excellent reduction and no operative complications occurred. Nine cases of them were followed up for 8 to 10 months,indicating bone healing. Conclusion The Stoppa approach has lots of advantages including simple dissection, anatomical clarity, small incision, low complica- tion rate and rapid rehabilitation. The Stoppa approach is a satisfactory choice for the management of complicated fractures of anterior pelvic ring.