改良Stoppa入路联合髂窝入路髂坐钢板固定治疗复杂髋臼骨折  

Operative treatment of complex acetabular fractures with ilioischial plating via modified Stoppa and iliac fossa approaches

作　　者：吴照祥[1] 欧艺[1] 陈戈[1] 陈仲[1] 毕鑫[1] 赵航[1] 

机构地区：[1]云南省第二人民医院创伤救治中心,昆明650021

出　　处：《中华创伤骨科杂志》2017年第8期655-661,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨改良Stoppa入路联合髂窝入路髂坐钢板固定治疗复杂髋臼骨折的疗效。方法回顾性分析2014年1月至2015年12月期间收治的40例复杂髋臼骨折患者资料。根据治疗方式不同分为试验组与对照组（n=20）。试验组男12例，女8例；平均年龄为（46．8±10．3）岁；采用改良Stoppa入路联合髂窝入路，于髂骨至耻骨铺设钢板稳定前柱，于骨盆内侧由髂骨至坐骨铺设髂坐钢板固定后柱骨折。对照组男10例，女10例；平均年龄为（45．6±11．7）岁；采用前方改良Stoppa入路或联合髂窝入路，于髂骨至耻骨铺设钢板稳定前柱，联合后方Kocher-Langenbeck入路，常规由髂骨至坐骨铺设重建钢板固定后柱骨折。比较两组患者的临床疗效。结果40例患者术后获平均18个月（8。24个月）随访。试验组患者手术时间[（2．1±0．7）h]显著短于对照组患者[（2．9±0．6）h]，术中出血量[（320．8±100．4）mL]显著少于对照组患者[（621．6±118．7）mL]，差异均有统计学意义（P〈0．05）。术后骨折复位质量按改良Matta标准评定：试验组优15例，良3例，可1例，差1例，优良率为90％；对照组优17例，良1例，可1例，差1例，优良率为90％。末次随访时按改良的Merle d’Aubign6和Postel功能评分系统评定患髋功能：试验组优14例，良3例，可2例，差1例，优良率为85％；对照组优12例，良4例，可3例，差1例，优良率为80％。以上项目两组之间比较差异均无统计学意义（P〉0．05）。试验组与对照组患者健康调查简表评分、术后并发症发生率比较差异均无统计学意义（P〉0．05）。结论改良Stoppa入路联合髂窝入路髂坐钢板固定治疗复杂髋臼骨折具有固定可靠、损伤小及术中出血量少等优点。Objective To investigate the effectiveness of ilioischial plating through modified Stoppa and iliac fossa approaches for complex acetabular fractures. Methods A consecutive series of 40 patients with complex acetabular fracture were treated operatively from January 2014 to February 2015. Of them, 20 were treated through modified Stoppa plus iliac fossa approaches as an experimental group （including 12 males and 8 females with a mean age of 46. 8 ± 10. 3 years） . The anterior column was stabilized with a recon- struction plate for the iliac wing along the iliopectineal line to the pubis in all cases. The posterior column was fixed with a newly developed ilioischial plate running from the ilium to the ischial ramus. The other 20 patients （10 males and 10 females with a mean age of 45.6 ± 11.7 years） served as a control group, treated with a reconstruction plate for the conventional posterior column fixation through the Kocher-Langenbeck approach. The 2 groups were compared in terms of operative time, intraoperative blood loss, reduction and functional recovery of the hip. Results The 40 patients obtained an average follow-up of 18 months （from 8 to 24 months） . The experimental group reported significantly shorter operation time （2. 1 ± 0.7 hours） and signifi- cantly less intraoperative bleeding（320.8 ± 100. 4 mL） than the control group（2.9 ±0.6 hours and 621.6 ± 118.7 mL, respectively） （ P 〈 0. 05）. According to modified Matta＇s criteria for reduction, the experimental group had 15 excellent, 3 good, one fair and one poor Cases （giving an excellent to good rate of 90% ） while the control group had 17 excellent, one good, one fair and one poor cases （giving an excellent to good rate of 90% ） . According to the modified Merle d＇Aubign6 and Postel scoring for the functional recovery of the affected hip at the final follow-ups, the experimental group had 14 excellent, 3 good, 2 fair and one poor cases （giving an excellent to good rate of 85% ） while the control group

关 键 词：髋臼 骨折 骨板 骨折固定术 内 手术入路 

分 类 号：R687.3[医药卫生—骨科学]