改良Stoppa入路治疗骨盆前环骨折

Modified Stoppa approach for treatment of fracture of anterior pelvic ring

目的 探讨改良Stoppa入路治疗骨盆前环骨折的疗效. 方法 回顾性分析2009年3月至2013年6月收治的40例（55侧）骨盆前环骨折患者资料,男24例（31侧）,女16例（24侧）;平均年龄为34.4岁（21 ～ 65岁）.骨折Tile分型：A型2例,B型21例,C型17例.受伤至手术时间平均为6.5 d（3 ～12 d）.所有患者均采用改良Stoppa入路手术,其中23例患者采用单纯骨盆前环钢板固定,17例患者采用骨盆前环钢板加后环固定.记录患者的切口长度、手术时间、术中出血量、骨折复位质量及疗效等. 结果 本组40例患者的手术切口长度平均为8.2 cm,手术时间平均为78.4 min,术中出血量平均为420 mL.术后根据Matta标准评定骨折复位质量：所有骨盆前环骨折均获满意复位.手术并发症：1例患者术中发生髂外血管损伤,1例患者取钢板后伤口迁延不愈.36例患者术后获8 ～ 24个月（平均18个月）随访,4例患者失访.骨折愈合时间为3.0～5.5个月,平均3.8个月.末次随访时采用Majeed功能评分系统评定疗效：评分平均为84.4分;优21例,良13例,可2例,优良率达95.0％.随访期间无一例患者发生骨折不愈合、延迟愈合或畸形愈合及异位骨化等并发症. 结论在骨盆前环骨折的治疗中,改良Stoppa入路具有手术切口小、术野清晰、复位效果好、并发症少且术后功能恢复快等优点.

Objective To evaluate the modified Stoppa approach for treatment of fracture of anterior pelvic ring.Methods From March 2009 to June 2013,40 patients with fracture of anterior pelvic ring （55 sides） were treated through the modified Stoppa approach at our department.They were 24 males （31 sides） and 16 females （24 sides）,aged from 21 to 65 years （average,34.4 years）.According to the Tile classification,2 cases were type A,21 cases type B and 17 cases type C.The mean time from injury to surgery was 6.5 days （from 3 to 12 days）.Simple plate fixation of the anterior pelvic ring was performed in 23 cases while 17 cases underwent plate fixation of the anterior pelvic ring plus additional fixation of the posterior pelvic ring.The incision length,operation time,blood loss,reduction quality and clinical rehabilitation were documented.Results On average,incision length was 8.2 cm,operation time 78.4 min and blood loss 420 mL for this cohort.According to Matta standard,all the 55 fractures obtained excellent reduction.Intraoperative vascular injury occurred in one case and delayed wound healing after plate removal in another.Of this group,36 were followed up from 8 to 24 months （average,18 months） and 4 lost.The fractures healed after 3 to 5.5 months （average,3.8 months）.The functional evaluation by the Majeed system scored an average of 84.4 points.Twenty-one cases were rated as excellent,13 as good and 2 as fair,resulting in an excellent and good rate of 95.0％.No nonunion,delayed union,malunion or heterotopic ossification was found in the follow-ups.Conclusion In treatment of fracture of anterior pelvic ring,the modified Stoppa approach has advantages of small incision,fine visualization,quality reduction,a low rate of complications and rapid rehabilitation.