Stoppa入路在髋关节发育不良髋臼周围截骨术中的应用

Application of Stoppa approach in periacetabular osteotomy for treatment of hip dysplasia

目的 探讨Stoppa入路联合髂嵴切口应用于髋关节发育不良髋臼周围截骨术的安全性及有效性.方法 2011年9月至2012年7月接受髋臼周围截骨术中应用Stoppa入路的髋关节发育不良患者18例20髋,女15例17髋,男3例3髋.患者年龄19～35岁,平均29岁.手术切口采用腹部横切口（即Stoppa入路）联合髂嵴切口（髂腹股沟入路的外侧窗）.记录手术时间、切口长度、术中出血量和异体血输血量,术后12个月门诊随访时评估髋关节功能、影像学征象和手术相关并发症.结果 手术时间125～180 min,平均145 rmin.Stoppa入路腹部横切口长5～10 cm,平均7 cm;髂嵴切口长4～8 cm,平均6 cm;切口总长度为12～16 cm,平均13 cm.术中出血量为500～1 600 ml,平均800 ml;异体血输血量为400～2400 ml,平均1 161 ml.术后随访14～22个月,平均19.6个月.Harris髋关节评分由术前（80.3±8.5）分改善至术后12个月时（93.5±5.2）分,平均改善（13.2±6.0）分;中心边缘角由术前7.5°±5.4°改善至30.0°±4.6°,平均改善225°±4.5°.手术前后Harris髋关节评分与中心边缘角的差异均有统计学意义.全部截骨均愈合,愈合时间3～6个月,平均3.3个月.2髋耻骨支截骨延迟至术后6个月愈合.3例术后出现一过性股外侧皮神经麻痹,未予特殊处理.结论 Stoppa入路联合髂嵴切口能够安全有效地完成髋臼周围截骨术,可以代替传统的髂腹股沟入路用于无须髋关节探查的轻度髋关节发育不良患者.

Objective To evaluate the safety and effectiveness of Stoppa approach combined with iliac incision in periacetabular osteotomy for treatment of hip dysplasia.Methods From September 2011 to July 2012,18 patients （20 hips） with hip dysplasia were performed periacetabular osteotomy through Stoppa approach combined with iliac incision.There were 15 female patients with 17 hips and 3 male patients with 3 hips.The average age was 29 years old （range 19 to 35）.The surgical incision included two parts with the abdominal transverse incision （Stoppa approach） and the iliac incision （the lateral window of ilioinguinal approach）.The duration of surgery,length of incision,intraoperative blood loss,and amount of allogeneic blood transfusion were measured.The clinical function,radiographic parameters,and operative complications were analyzed at 12 months follow-up.Results The mean operation time was 145 min （range,125-180 min）.The mean incision length of Stoppa approach was 7 cm （range,5-10 erm） for the abdominal part and 6 cm （range,4-8 cm） for the iliac part,and the average of total incision length was 13 cm （range,12-16 cm）.The mean blood loss during operation was 800ml （range,500-1 600 ml）.The mean amount of allogeneic blood transfusion was 1 161 ml （range,400-2 400 ml）.The mean duration of follow-up was 19.6 months （range,14-22 months）.Compared to the preoperative data,both postoperative Harris hip score and center-edge angle improved significantly,with a mean increase of 13.2±6.0 and 22.5°±4.5° respectively.The mean Harris hip score improved form 80.3±8.5 preoperatively to 93.5±5.2 postoperatively at the time of 12 months follow-up.The average center-edge angle improved from 7.5°±5.4° preoperatively to 30.0°±4.6° postoperatively.All of the osteotomies except two pubic osteotomies healed at the time of three months follow-up.The two pubic osteotomies were treated with protected weight bearing and had a delayed union until the six months follow-up.The mean time of osteotomies union was 3.3 months.Complications included three transient]ateral femoral cutaneous nerve palsies which completely resolved within three months after oral medicine therapy.There were no major neurovascular complications,no infection,no incision hernia or any other surgical complications.Conclusion Stoppa approach combined with iliac incision is a safe and effective approach for periacetabular osteotomy.It is an alternative to conventional ilioinguinal approach for treatment of mild hip dysplasia.