改良Stoppa入路治疗髋臼前部骨折  

Modified Stoppa approach for acetabular anterior fractures

作　　者：李贵坚 陈亚洲[1] 刘培倦 罗佳武 

机构地区：[1]广东省南雄市人民医院骨科,512400

出　　处：《中华创伤骨科杂志》2017年第2期173-175,共3页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨采用改良Stoppa入路治疗髋臼前部骨折的临床疗效。方法回顾性分析2011年1月至2014年12月期间收治的22例髋臼前部骨折患者资料。男14例，女8例；年龄为18-49岁，平均36．6岁。骨折LetourneI-Judet分型：髋臼前壁骨折9例，前柱骨折12例，横形骨折1例。所有患者均采用改良Stoppa入路直视下复位骨折，透视证实骨折复位满意后用重建钢板固定。记录患者的手术时间、手术切口长度、术中出血量、骨折复位质量、患髋功能及术后并发症发生情况等。结果本组患者的切口长度为6-15cm，平均9．5cm；术中出血量为100-1000mL，平均550mL；手术时间为40-160min，平均126．2min。22例患者术后获12-18个月（平均15．5个月）随访。骨折复位质量按Matta评分标准评定：优18例，良3例，差1例，优良率为95．5％。末次随访时根据髋关节Harris评分标准评定患髋功能：优12例，良9例，差1例，优良率为95．5％。1例患者术后发生创伤性关节炎。随访期间无骨折复位丢失、钢板螺钉松动或断裂等并发症发生。结论改良Stoppa入路治疗髋臼前部骨折具有手术切151小、解剖清晰、可直视下复位固定骨折、手术时间短、术中出血量少及术后并发症少等优点，临床疗效可靠。Objective To discuss clinical efficacy of the modified Stoppa approach in the treatment of acetabular anterior fractures. Methods From January 2011 to December 2014, 22 patients with acetabular anterior fracture were treated at our department. They were 14 males and 8 females, with an average age of 36.6 years （range, from 18 to 49 years） . By the LetourneI-Judet classification system, there were 9 anterior wall fractures, 12 anterior column fractures, and one transverse fracture. The modified Stoppa approach was used for fracture reduction under direct visualization in this cohort. Fixation with reconstruction plate was conducted after satisfactory reduction was confirmed by the X-ray examination. The operative duration, incision length, bleeding volume, fracture reduction quality, function of the affected hip and complications were recorded. Results In this cohort, the incision length ranged from 6 to 15 cm, averaging 9.5 cm; the intraoperative bleeding volume ranged from 100 to 1, 000 mL, averaging 550 mL; the operative duration ranged from 40 to 160 minutes, av- eraging 126.2 rain. The 22 patients were followed up for an average of 15.5 months （from 12 to 18 months） . According to the Matta imaging evaluation, the fracture reduction was rated as excellent in 18 cases, as good in 3 cases and as poor in one, yielding an excellent to good rate of 95.5%. According to the Harris scoring system, the function of the affected hip was assessed at the final follow-up as excellent in 12 cases, as good in 9 cases, and as poor in one case, giving an excellent to good rate of 95.5%. Traumatic arthritis occurred in one case; there were no such complications as reduction loss or implant failure. Conclusion The modified Stoppa approach is a satisfactory one for the treatment of unstable acetabular anterior fractures, owning to its advantages like minimal invasiveness, simple dissection, excellent visual control of reduction and fixation, and a low rate of complications.

关 键 词：髋臼 骨折 骨折固定术 内 Stoppa入路 

分 类 号：R687.3[医药卫生—骨科学]