新改良Stoppa入路治疗骨盆、髋臼骨折

Modified Stoppa approach for treatment of pelvic and acetabular fractures

目的总结新改良Stoppa入路治疗骨盆、髋臼骨折的临床经验,探讨其应用价值。方法采用新改良Stoppa入路手术治疗骨盆、髋臼骨折患者19例。骨盆骨折者采用前路钢板固定后应用骨盆外固定器进行固定;髋臼骨折者如后柱骨折移位较大,联合应用髋关节后外侧入路。结果切口长度10～13(11.04±0.73)cm,手术时间80～270(120.33±35.80)min,术中出血量400～1 200(601.47±176.92)ml,无手术并发症。根据Matta评分对术后X线片进行测量,骨折复位优16例,良3例。15例患者获得随访,时间3～9个月。13例功能满意,2例患侧髋部偶有疼痛,其中1例有轻度跛行。结论新改良Stoppa入路具有切口小、解剖清晰、固定操作简单等优点,作为髂腹股沟入路之外的选择,在治疗骨盆、髋臼骨折时具有独到的应用价值。

Objective To summarize the clinical experiences using the newly modified Stoppa approach in the treatment of pelvic and acetabular fractures and to investigate the value of application. Methods 19 cases of pelvic and acetabular fractures were treated with the newly modified Stoppa approach. For patients of pelvic fractures, the pelvic external fixation was used after the anterior plate was inserted. For patients of acetabular fractures, the posterior approach was adopted firstly if there was sever displacement in the posterior column. Results Incision length ranged from 10- 13 （11.04 ±0. 73） cm, operation time and blood loss ranged from 80- 270 （120. 33 ±35.80） min and 400 - 1200 （601.47 ± 176. 92） ml respectively. No operative complications were observed. The postoperative radiographs showed the reduction of the acetabular fractures were excellent in 16 cases and good in 3 according to Matta score. 15 cases were followed up for 3 -9 months. 13 cases got satisfactopy functional results, 2 cases felt moderate pain on the injured acetabulum and 1 case of them had slight limb. Conclusions The newly modified Stoppa approach has advantages of small incision, anatomical clarity and simple fixation maneuver. As another choice besides the ilioinguinal approach, the newly modified Stoppa approach has special value for treatment of pelvic and acetabular fractures.