改良Stoppa入路在髋臼骨折手术中的应用效果分析

Modified Stoppa Approach for Acetabular Fractures

目的 探讨改良Stoppa入路在髋臼骨折手术中的应用效果.方法 选择我院2008年3月-2012年4月收治的髋臼骨折患者共31例,其中男23例,女8例;年龄16～58岁,平均38.5岁;Letournel分型：双柱骨折13例,前柱骨折8例,横型骨折4例,前柱伴后半横型骨折4例,T型骨折2例;单独采用改良Stoppa入路23例,8例加用Kocher-Langenbeck入路（K-L入路）处理后柱骨折,3例加用髂窝入路进行复位和固定.结果 骨折复位：解剖复位27例,满意复位3例,不满意复位1例,复位满意率为30/31;临床结局：随访时间为6个月～4年,平均2.8年,优15例,良12例,可3例,差1例,优良率为27/31.并发症：膀胱破裂1例,股骨头坏死1例,2例残存不同程度肌力障碍,异位骨化3例;无一例出现医源性坐骨神经损伤、切口感染、深静脉血栓等.结论 在髋臼手术中,改良Stoppa入路暴露充分,对四边体和部分前后柱骨折均能够在直视下复位,具有操作简单、术后恢复快、并发症少等优点.

Objective To discuss the effects of modified Stoppa approach for acetabular fractures.Methods A total of 31 acetabular fracture patients（23 males,8 females;aged 16-58 years,meanly 38.5 years old）admitted to this hospital from March 2008 to April 2012 had letournel typing：13 had double-column fracture,8 had anterior column fracture,4 had transverse fracture,2 had T-type fracture.Twenty-three patients were treated only through modified stoppa approach,8 combined with K-L approach to treat posterior column fracture,3 combined with iliac fossa approach to reset and fix.Results Twenty-seven patients had anatomic reduction,3 had satisfactory reduction,1 had dissatisfactory reduction,with a satisfaction rate of 30/31.The follow-up lasted 6 months-4 years,meanly 2.8 years.Fifteen patients had excellent effect,12 had good,3 had general,1 had poor.The good rate was 27/31.One patient had vesical rupture,1 had osteonecrosis,2 had varying degrees of residual muscle disorders,3 had heterotopic ossification,no one had iatrogenic injury of sciatic nerve,postoperative infection,deep vein thrombosis etc..Conclusion In acetabular surgery,modified Stoppa approach,which has full exposure and can do reduction of fractures of quadrilateral surface and some areas of anterior,posterior columns under direct vision,is easy to do,recovers in shorter time and has fewer complications.