改良Stoppa小切口空心螺钉固定治疗骨盆前环骨折

Cannulate screw fixation via a modified Stoppa limited approach for anterior ring pelvic fractures

目的探讨改良Stoppa 小切口结合空心螺钉固定治疗骨盆前环骨折的疗效.方法回顾性分析2009 年6 月至2013 年12 月西安交通大学医学部附属红会医院采用改良Stoppa 小切口空心螺钉固定治疗30 例骨盆前环骨折患者的临床资料.按Tile 分型A2型6 例、B2型8 例、B3型12 例、C2型4 例,其中5 例结合后环经皮骶髂空心螺钉固定.应用Matta 评分标准和Majeed 功能评分系统对骨折复位及术后功能进行评价.结果切口长度5～7 cm（平均6.3 cm）,手术时间50～70 min（平均56 min）,术中出血量150～400 mL（平均280 mL）.依据Matta 标准,30 例骨盆前环骨折均获满意复位.27 例患者获得随访,随访时间18～48 个月（平均32 个月）;3 例失访.随访患者术后12～16 周（平均14.5 周）均获骨性愈合.随访期间Majeed 评分呈上升趋势,患者术后功能逐渐好转.术后1 个月：优4 例、良10 例、可12 例、差4 例;术后6 个月：优14 例、良8 例、可6 例、差2 例;末次随访：优20 例、良5 例、可2 例.结论改良Stoppa 小切口空心螺钉固定具有创伤小、手术时间短、恢复快等特点,是治疗骨盆前环骨折的较好选择.

Objective To explore the clinical effects of cannulate screw fixation via a modified Stoppa limited approach for anterior ring pelvic fractures. Methods Clinical data of 30 patients with anterior ring pelvic fractures treated through a modified Stoppa limited approach in Xi'an Red Cross Hospital Affiliated to College of Medicine, Xi'an Jiaotong University from June 2009 to December 2013, were analyzed retrospectively. According to fracture classification of Tile, there were 6 cases of A2, 8 cases of B2, 12 cases of B3, and 4 cases of C2. All patients underwent cannulate screw fixation, in which 5 patients combining with posterior ring percutaneous sacroiliac screw fixation. Fracture reduction and postoperative function were evaluated by Matta and Majeed scores. Results The mean length of incision was 6.3 cm(range 5 to 7 cm), the mean operation time was 56 min(range 50 to 70 min), and the mean intraoperative estimate blood loss was 280 m L(range 150 to 400 m L).According to Matta score, all patients obtained satisfactory reduction. A total of 27 patients obtained follow-up,with the average follow-up time of 32 months(18-48 months), and the other 3 patients were lost. During the follow-up, all patients achieved bony union around 12 to 16 weeks(average, 14.5 weeks) postoperatively.According to Majeed score, postoperative functions were improved gradually. One month after the operation,there were excellent in 4 cases, good in 10, fair in 12 and poor in 4 cases; At 6 months postoperatively, there were excellent in 14 cases, good in 8, fair in 6 and poor in 2 cases; At the latest follow-up, there were excellent in 20 cases, good in 5 and fair in 2 cases. Conclusions The modified Stoppa limited approach has the advantages of less injuries, short operation time and fast rehabilitation; Cannulate screw fixation via the approach is a good choice for the treatment of anterior ring pelvic fractures.