改良Stoppa入路联合髂窝入路治疗复杂髋臼骨折  

Treatment of complex acetabular fractures via modified Stoppa approach plus iliac fossa approach

作　　者：邹昌[1] 方跃[1] 屠重棋[1] 刘雷[1] 王光林[1] 黄富国[1] 

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中华创伤骨科杂志》2015年第8期669-675,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨改良Stoppa入路联合髂窝入路治疗复杂髋臼骨折的临床疗效。方法回顾性分析2008年1月至2014年6月收治的36例复杂髋臼骨折患者资料，男24例，女12例；年龄为18—62岁，平均38．6岁；髋臼骨折按Letoumel—Judet分型：双柱骨折16例，前柱伴后半横形骨折12例，T形骨折6例，前柱骨折2例。所有患者均采用改良Stoppa入路联合髂窝入路，于真骨盆缘上方及内侧髂骨翼处固定骨折。记录患者的骨折复位质量、手术时间、术中出血量、输血量、引流量、并发症发生情况及末次随访时的髋关节功能等。结果本组患者的手术时间平均为225min，术中出血量平均为870mL，引流量平均为128mL，输血量平均为380mL。36例患者术后获12．48个月（平均36个月）随访。手术并发症：闭孔神经损伤3例，髂外静脉损伤1例。术后骨折复位质量采用Matta评分标准评定：优18例，良13例，差5例，优良率为86．1％。骨折愈合时间平均为6．4个月（4．5～9．0个月）。末次随访时根据改良Merle d＇Aubigne和Postel评分系统评定髋关节功能：优16例，良13例，可5例，差2例，优良率为80．6％。3例患者术后发生创伤性关节炎，1例患者术后发生股骨头缺血性坏死，经治疗后恢复较好。结论改良Stoppa入路联合髂窝入路在暴露方形区及真骨盆缘区域具有一定优势，可直视下复位并固定方形区骨折，是一种治疗复杂髋臼骨折的良好手术入路选择。Objective To evaluate the clinical outcomes of modified Stoppa approach plus iliac fossa approach in the treatment of complex acetabular fractures. Methods Thirty-six patients with complex acetabular fracture were treated from January 2008 to June 2014 at our department. They were 24 males and 12 females, aged from 18 to 62 years （average, 38.6 years） . By the Letournel-Judet classification, there were 16 double column fractures, 12 anterior column and half transverse fractures, 6 T-shaped fractures, and 2 anterior column fractures. All the fractures were fixated via the modified Stoppa approach plus the iliac fossa approach above or inside the true pelvis edge and the iliac wing. Clinical evaluation involved operative time, blood loss, blood transfusion, wound drainage, postoperative complications, and hip function at the last follow-ups. Results The mean operative time was 225 min, mean blood loss 870 mL, mean drainage 128 mL, and mean transfusion volume 380 mL. The 36 patients were followed up for 12 to 48 months （average, 36 months）. Surgical complications were found in 4 cases, including obturator nerve injury in 3 and external iliac vein injury in one. According to the Matta criteria, fracture reduction was excellent in 18 cases, good in 13 and poor in 5. The fractures healed after an average of 6.4 months （from 4. 5 to 9.0 months）. According to the Merle d＇ Aubigne-Postel criteria at the last follow-ups, hip function was excellent in 16 cases, good in 13, fair in 5 and poor in 2, giving an excellent to good rate of 80. 6%. Traumatic arthritis occurred in 3 cases and femoral head necrosis in one, but the complications all responded to treatment. Conclusion The modified Stoppa approach combined with iliac fossa approach is a good alternative in the treatment of complex acetabular fractures, because it provides such an advantage as exposure of quadrilateral surface and the true pelvis edge which allows for reduction and plating under direct visualization.

关 键 词：髋臼 骨折 骨折固定术  内 改良STOPPA入路 

分 类 号：R687.3[医药卫生—骨科学]