改良Stoppa入路切开复位内固定治疗Tile C型骨盆骨折合并髋臼双柱骨折

Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures

目的探讨改良Stoppa入路切开复位内固定治疗Tile C型骨盆骨折合并髋臼双柱骨折的近期临床疗效。方法回顾性分析2014年4月至2017年4月期间广东医科大学附属佛山高明医院骨科采用改良Stoppa入路切开复位内固定治疗的14例Tile C型骨盆骨折合并髋臼双柱骨折患者资料。男10例,女4例;年龄为23~57岁,平均36.4岁。采用单一改良Stoppa入路4例,联合髂窝入路3例,联合Kocher-Langenbeck入路4例,联合髂窝入路和Kocher-Langenbeck入路3例。术中应用重建钢板结合螺钉、拉力螺钉等固定技术治疗。记录本组患者的手术时间、术中出血量、骨折复位质量、骨折愈合时间、疗效及并发症发生情况等。结果14例患者的手术时间平均为170 min(110~330 min),术中出血量平均为420 mL(240~1100 mL),无手术并发症发生。按照Matta评分标准评定术后骨折复位质量:14例患者骨盆骨折复位均为优;髋臼双柱骨折复位优9例,良5例。13例患者术后获平均19个月(12~29个月)随访,1例失访。骨折愈合时间平均为3.4个月(2.7~4.6个月)。1例患者螺钉出现松动,1例患者发生髋关节轻度屈曲受限。随访期间无一例患者发生腹壁疝、股骨头缺血性坏死等其他并发症。末次随访时髋关节Harris评分为70~94分,平均84分;其中优6例,良5例,可2例。结论改良Stoppa入路能够单独或联合其他手术入路切开复位内固定治疗Tile C型骨盆骨折合并髋臼双柱骨折,近期疗效良好。

Objective To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures.Methods Between April 2014 and April 2017,a total of 14 patients were treated by open reduction and internal fixation(ORIF)through the modified Stoppa approach at Department of Orthopaedics,Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures.They were 10 men and 4 women,with an average age of 36.4 years(from 23 to 57 years).The modified Stoppa approach was used exclusively in 4 cases,in combination with the iliac fossa approach in 3 ones,in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones.In all the patients,the pelvic reconstructive plate and screws and lag screws were used.The operation time,intraoperative bleeding volume,postoperative fracture reduction,fracture union time,efficacy and complications were recorded.Results The operation time averaged 170 min(from 110 to 330 min)and the intraoperative bleeding 420 mL(from 240 to 1100 mL).There were no operative complications.By the Matta evaluation,the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures.Of this series,13 patients were followed up for an average of 19 months(from 12 to 29 months)and one was lost to the follow-up.The fractures got united after an average time of 3.4 months(from 2.7 to 4.6 months).Screw loosening was observed in one case and mild limitation to hip flexion in one.Follow-ups found no lateral ventral syndrome or femoral head necrosis.Their Harris hip scores at the last follow-up ranged from 70 to 94 points,averaging 84 points.The function of the affected hip was excellent in 6 cases,good in 5 and fair in 2.Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures,leading to good short-term clinical outcomes.