改良Rives-Stoppa入路与髂腹股沟入路治疗髋臼骨折的比较性研究

Comparison study on modified Rives-Stoppa approach and ilioinguinal approach in treatment of acetabular fractures

目的评估改良Rives-Stoppa入路与髂腹股沟入路治疗髋臼骨折的临床疗效。方法选择2002-2013年我科收治的髋臼骨折切开复位内固定手术患者54例,采用回顾性比较研究方法。2002-2010年采用髂腹股沟入路33例,2008-2013年采用改良Rives-Stoppa入路21例,比较两组的手术时间、术中出血量、复位效果、早期术后并发症、临床疗效。结果改良Rives-Stoppa入路较髂腹股沟入路手术时间短、术中出血量少。在髋臼骨折复位固定方面均获得满意结果。改良Rives-Stoppa入路获得了更好的解剖复位率（P〈0.05）。结论改良Rives-Stoppa入路与髂腹股沟入路相比显露更清楚,复位效果更好,是一种安全有效的选择。改良Stoppa入路最大优点是术者能够站在对侧从髋臼后柱及四边体骨折的顶部直接复位并应用支撑钢板固定,操作更简单。

Objective To compare the clinical result of modified Rives-Stoppa approach and Ilioinguinal approach in treatment of acetabular fractures. Methods A total of 54 patients with acetabular fractures were treated at our institution from 2002 to 2013. Comparison of 33 cases operated from 2002 to 2010 with the ilioinguinal approach and 21 cases operated from 2008 to 2013 with the modified Rives-Stoppa approach was done. Retrospective study was underwent. The operation time, intraoperative bleeding, and the clinical efficacy were compared between the two groups. Results The modified Rives-Stoppa approach had advantages of less operation time and less intraoperative bleeding compared with the ilioinguinal approach. The clinical efficacy was satisfactory in both two groups. Anatomical reduction rate was better in the modified Rives-Stoppa approach group than in the ilioinguinal approach group, and the difference was significant between the two groups（P0.05）. Conclusion The modified Rives-Stoppa approach, which offers better exposure and improved reduction quality of acetabular fractures, is a safe alternative that compared with the ilioinguinal approach. The major advantage of the modified Rives-Stoppa approach is that it enables reduction of the posterior column and the quadrilateral plate from the contralateral side and enables application of a buttress plate below the pelvic brim.