改良Stoppa入路在髋臼骨折中应用探讨  

Surgical Treatment of Acetabular Fractures by Modified Stoppa Approach

作　　者：贾俊峰[1] 梁伟之 傅磊[1] 崔晓虎[1] 李威[1] 

机构地区：[1]武警山西总队医院骨一科,山西太原030006

出　　处：《实用骨科杂志》2013年第7期595-597,672,共4页Journal of Practical Orthopaedics

摘　　要：目的评价改良Stoppa入路在治疗髋臼骨折中的疗效。方法回顾性分析我科2006年1月至2012年1月间手术治疗部分髋臼骨折72例的临床资料,其中应用单一髂腹股沟入路治疗41例,应用改良Stoppa入路治疗31例。结果髂腹股沟组平均手术用时125.4min,术中平均出血量为650mL,术后出现深部感染1例,股外侧皮神经损伤2例,异位骨化1例,患侧下肢深静脉血栓1例;改良Stoppa组平均手术用时85.8min,术中平均出血量为410mL,术后出现患侧深静脉血栓1例。骨折复位情况按Matta复位标准,髂腹股沟组复位满意率为85.4%,改良Stop-pa组为87.1%。两组患者均获随访9个月～3年,平均15.7个月,骨折处均骨性愈合。关节功能按照改良的MerledAubigne和Postel评分系统进行评估,髂腹股沟组优良率为82.9%,改良Stoppa组为83.9%。两组复位满意率、关节功能优良率及并发症发生率差异无统计学意义(P>0.05);而手术用时及术中出血量,改良Stoppa组明显少于髂腹股沟组,差异有统计学意义(P<0.01)。结论与髂腹股沟入路相比,改良Stoppa入路具有显露充分、创伤小、并发症少,、出血少的优点,某些情况下可替代传统的髂腹股沟入路,是治疗髋臼骨折的理想入路之一。Objective To evaluate the effect of the surgical treatment in acetabular fractures through modified Stoppa approach. Methods The clinical data of 72 cases of selective acetabular fractures treated in our hospital were studied retrospectively. Among them, 41 cases received operations through single ilioinguinal approach ,and 31 through modified Stoppa approach. Results The average time of operation was 125.4 minutes in group of single ilioinguinal approach,the average amount of intraoperative blood was 650 mL. 1 case with infection, 2 cutaneous nerve of thigh injury, 1 ectopic ossification and 1 deep venous thrombosis （DVT） in pelvic limb were observed. The average time of operation was 85.8 minutes in group of modified Stoppa approach,the average amount of intraoperative blood was 410 mL, 1 case with deep venous thrombosis （DVT） was observed. According to Matta standard,the excellent and good rate of reduction in single ilioinguinal approach group was 85.4%and 87.1 % in modified Stoppa approach. The fol- low-up was 9-36 months,an average of 15.7 months. All the fructrues healed. The modified Merled＇Aubigne and Postel score system showed that the joint functional fineness ratio was 82. 9% and 83. 9%in modified Stoppa ap- proach group. There were not statistically difference in the excellent and good rate of reduction, the joint functional fineness ratio and the incidence rate of complication （P^0.05） ,but in the average time of preoperation and amount of intraoperative blood（P^0.01）. Conclusion Because of the particular advantages of perfect exposure,minimally inva sion,fewer complication and blood loss,modified Stoppa approach is one of the perfect operative approaches for acetabular fractures and can substitute for the traditional ilioinguinal approach in some cases.

关 键 词：髋臼骨折 手术入路 疗效 

分 类 号：R683.42[医药卫生—骨科学]