Stoppa入路手术治疗骨盆前环骨折

Modified Stoppa approach for treatment of anterior pelvic ring fractures

目的探讨应用Stoppa手术入路治疗骨盆前环骨折的疗效和可行性。方法对2008年6月-2011年8月采用改良Stoppa手术入路治疗的21例骨盆前环骨折患者的治疗效果进行总结分析。按Tile分类方法：A2类型7例，B2类型6例，B3类型5例，c2类型3例。均采用Stoppa入路行手术治疗。其中14例采用骨盆前环钢板固定，4例采用骨盆前环钢板加外固定器固定，另外3例则采用骨盆前环钢板和骶髂关节空心加压螺钉固定。应用Matta评分标准和Majeed功能评分系统对骨折复位及术后功能进行评价。结果Stoppa手术入路切口长度为10-12cm，平均11cm；手术时间70-120min，平均95min；术中出血量400-1000m1，平均700ml。依据Matta标准，21例患者骨盆前环骨折均获满意复位，其中15例患者术后得到8-20个月随访，均达骨性愈合。患者术后Majeed评分逐渐提高。结论Stoppa手术入路具有切口方便直接、手术视野清晰、易于复位、并发症少和恢复快的特点。在手术治疗骨盆前环骨折时，Stoppa入路是一个理想的选择。

Objective To investigate the feasibility and effects of modified Stoppa approach in treatment of anterior pelvic ring fractures. Methods The therapeutic effects of 21 patients with anteri- or pelvic ring fractures treated through the modified Stoppa approach from June 2008 to August 2011 were summarized and analyzed. According to Tile classification, there were seven patients with type A2 frac- tures, six with type B2 fractures, five type B3 fractures and three type C2 fractures. Surgical treatment through the modified Stoppa approach included anterior pelvic ring plates for 14 patients, anterior pelvic ring plates and external fixators for four and anterior pelvic ring plates and sacroiliac joint compressed can- nulated screws for three. The fracture reduction and post-operative function were assessed by Matta crite- ria and Majeed system respectively. Results The incision length of the modified Stoppa approach ranged from 10 to 12 cm （average, ll cm）. The operation time ranged from 70 to 120 minutes （average, 95 minutes）. The intra-operative blood loss ranged from 400 to 1 000 ml （average, 700 ml）. According to the Matta criteria, all 21 patients obtained sound reduction, of whom 15 patients had bony union after 8-20 months follow-up post-operatively. The Majeed score in all patients showed a gradual increase post- operatively. Conclusions The modified Stoppa approach is characterized by convenience and direct- ness in making incisions, clear operation field, easy reduction, few complications and fast recovery and hence is an ideal choice in surgical treatment of anterior pelvic ring fractures.