改良Stoppa入路治疗不稳定骨盆前环骨折

Application of modified Stoppa approach for the treatment of unstable fractures of anterior pelvic ring

目的探讨应用改良Stoppa入路治疗不稳定骨盆前环骨折的临床体会。方法回顾性分析应用改良Stoppa入路治疗15例骨盆前环骨折临床资料。骨盆骨折按照Tile分类:B1 1例,B2 2例,B3 5例,C1 2例,C2 1例,C3 4例;4例C3型均合并髋臼骨折:前柱伴后壁骨折1例,横型骨折2例,双柱骨折1例。单独使用改良Stoppa入路10例,联合后路经皮骶髂螺钉固定2例;联合Kocher-Langenbeck入路2例,联合髂窝入路双钢板固定后环1例。结果改良Stoppa入路平均切口长度10cm(8～13cm),平均手术时间110min(80～150min),平均出血600ml(300～1 000ml)。骨折均复位满意,随访4～18个月,均获骨性愈合,疗效满意。结论改良Stoppa入路具有损伤小、解剖清晰、操作简便、精确地直视下复位固定骨折、并发症少等优点,是治疗不稳定骨盆前环骨折的理想入路。

Objective To investigate the clinical experience of adopting the modified Stoppa approach in the treatment of unstable fractures of anterior pelvic ring .Methods A total of 15 cases of unstable fractures of anterior pelvic ring were treated through the modified Stoppa approach .According to the Tile＇s classification ,1 case was type B1,2 cases were type B2,5 cases were B3,2 cases were C1,1 case was C2 and 4 cases were C3.The cases of C3 were all combined with acetabular fracture ,including 1 anterior column/posterior wall fracture ,2 transverse fractures , and 1 both column fracture.The modified Stoppa approach was used exclusively in 10 cases,and together with posterior per-cutaneous sacroiliac screw fixation in 2 cases,Kocher-Langenbeck approach in 2 cases and iliac fossa approach in 1 case.Results The average incision length of the modified Stoppa approach was 10 cm（range from 8 to 13 cm）,the mean operation time and blood loss were 110 minutes （range from 80 to 150 minutes）and 600 ml（range from 300 to 1000 ml）respectively.All the fracture recovered satisfactorily .All cases were followed up for 4 to 18 months,indica-ting bone healing and satisfactory clinical results .Conclusion The modified Stoppa approach has many advantages including minimal invasiveness ,simple dissection ,excellent visual control of reduction and fixation ,and low complica-tion rates.It is a satisfactory approach for the treatment of unstable fractures of anterior pelvic ring .