改良Stoppa入路内侧壁弹力接骨板治疗累及髋臼方形区骨折  

MODIFIED Stoppa APPROACH WITH MEDIAL WALL SPRING PL ATE FOR INVOLVING QUADRILATERAL OF ACETABULUM FRACTURE

作　　者：杨亚军 岳建明 温鹏 

机构地区：[1]宁夏人民医院骨科,银川750001

出　　处：《中国修复重建外科杂志》2015年第3期270-274,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：宁夏自然科学基金资助项目(NZ11166)~~

摘　　要：目的探讨经改良Stoppa入路采用内侧壁弹力接骨板(medial wall spring plate,MWSP)治疗累及髋臼方形区骨折的临床疗效。方法 2008年3月-2013年9月,收治38例累及方形区的复杂髋臼骨折患者。男23例,女15例;年龄19~56岁,平均36.08岁。致伤原因:交通事故伤21例,重物压砸伤10例,高处坠落伤7例。伤后至入院时间3 h^2 d,平均11 h。骨折按照Letournel-Judet分型标准,前柱骨折(D型)12例,横形骨折(E型)5例,T形骨折(H型)8例,前柱并后半横形骨折(I型)6例,双柱骨折(J型)7例。根据骨折类型,选择改良Stoppa入路(19例)或分别联合髂腹股沟入路(10例)、Kocher-Langenbeck入路(9例),显露骨折部位,采用MWSP固定方形区骨折。观察手术时间、出血量、有无并发症发生,评价骨折复位效果及髋关节功能。结果手术时间为85~210 min,平均130 min;出血量450~900 m L,平均650 m L。术中1例血管撕裂,1例损伤膀胱;术后8例发生下肢静脉血栓形成,2例切口脂肪液化。术后CT复查示1例螺钉误植。根据Matta影像学评分标准,骨折达解剖复位9例,满意复位24例,不满意复位5例;骨折复位满意率为86.84%。3例患肢较健侧短缩0.8~1.0 cm。所有患者均获随访,随访时间7~18个月,平均10个月。骨折均愈合良好,愈合时间13~16周,平均14周。术后1年,根据Merled’Aubigne和Postel评分标准,获优9例,良21例,一般5例,差3例,优良率78.95%。结论采用单纯改良Stoppa入路或联合手术入路显露累及方形区的复杂髋臼骨折,操作相对简便、骨折复位满意、并发症少。采用MWSP固定方形区骨折,可获得稳定固定。Objective To investigate the effectiveness of modified Stoppa approach with medial wall spring plate （MWSP） for involving quadrilateral of acetabulum fracture. Methods Between March 2008 and September 2013, 38 patients with involving quadrilateral of acetabulum fracture were treated, including of 23 males and 15 females with an average age of 36.08 years （range, 19-56 years）. The causes included traffic accidents injury （21 cases）, crash injury of heavy object （10 cases）, and falling injury from height （7 cases）. The interval of injury and admission was 3 hours to 2 days （mean, 11 hours）. There were 12 cases of anterior column fracture （type D）, 5 cases of transverse fractures （type E）, 8 cases of T shaped fractures （type H）, 6 cases of anterior column fracture with posterior transverse fractures （type I）, and 7 cases of double column fractures （type J） according to Letournel-Judet classification. Based on fracture types, MWSP was used to fLX fracture by modified Stoppa approach in 19 cases or combined with the ilioinguinal approach in 10 cases or combined with Kocher-Langenbeck approach in 9 cases. The operation time, blood loss, and complications were recorded. The effectiveness of reduction and the hip function were evaluated according to Matta score system and Merled＇ Aubigne and Postel score system. Results The operation time was 85-210 minutes （mean, 130 minutes）.The intra-operative blood loss was 450-900 mL （mean, 650 mL）. There were 1 case of vascular avulsion, and 1 case of bladder injury during operation; there were 8 cases of venous thrombosis and 2 cases of fat liquefaction of incision after operation. Screw was implanted into the articular joint in 1 case on CT after operation. Matta X-ray assessment showed anatomicalreduction in 9 cases, satisfactory reduction in 24 cases, and unsatisfactory reduction in 5 cases, and the satisfaction rate of reduction was 86.84%. Three patients had limb shorting of 0.8-1.0 cm when compared with normal limb. All p

关 键 词：改良STOPPA入路 内侧壁弹力接骨板 髋臼骨折 方形区 

分 类 号：R687.3[医药卫生—骨科学]