经改良Stoppa入路跟骨钢板桥接重建钢板固定治疗累及方形区的髋臼骨折  

Calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach

作　　者：杨德顺[1] 王洋洋 王开明[1] 廖亮[1] 雷丙俊[1] 黄震[1] 张庆[1] YANG Deshun;WANG Yangyang;WANG Kaiming;LIAO Liang;LEI Bingjun;HUANG Zhen;ZHANG Qing(Department of Orthopedics,the Third People’s Hospital of Bengbu,Bengbu Anhui,233000,P.R.China)

机构地区：[1]蚌埠市第三人民医院骨科,安徽蚌埠233000

出　　处：《中国修复重建外科杂志》2020年第10期1253-1257,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨经改良Stoppa入路跟骨钢板桥接重建钢板固定治疗累及方形区的髋臼骨折的临床疗效。方法2015年1月—2017年12月,采用经改良Stoppa入路跟骨钢板桥接重建钢板固定治疗18例累及方形区的髋臼骨折患者。男12例,女6例;年龄28~63岁,平均39岁。致伤原因:交通事故伤13例,高处坠落伤5例。根据Letournel-Judet分型:双柱骨折10例,T型骨折6例,前柱伴后半横形骨折2例。受伤至手术时间6~24 d,平均8.6 d。术后复查X线片及CT,根据Matta影像学标准评价骨折复位质量;根据改良的Merled’Aubigné-Postel评分标准评价髋关节功能。结果手术时间120~240 min,平均165 min;术中出血量600~1400 mL,平均850 mL。患者均获随访,随访时间18~30个月,平均24.5个月。术后2例腹壁切口脂肪液化,3例出现股外侧皮神经支配区域麻木,1例下肢深静脉血栓形成,1例因术中误损伤膀胱出现腹痛、血尿。术后根据Matta影像学标准评价骨折复位质量,其中解剖复位12例、满意复位5例、不满意复位1例,复位满意率为94.4%。骨折均获骨性愈合,愈合时间3~5个月,平均3.4个月。随访期间无1例发生内固定物松动、断裂或骨折再次移位。末次随访时,根据改良的Merled’A ubigné-Postel评分标准,髋关节功能获优11例、良4例、可2例、差1例,优良率为83.3%。结论经改良Stoppa入路跟骨钢板桥接重建钢板固定治疗累及方形区的髋臼骨折可获得满意疗效。Objective To explore the effectiveness of the calcaneal plate bridge reconstruction plate for acetabular fracture involving quadrilateral surface via modified Stoppa approach.Methods Between January 2015 and December2017,18 patients with acetabular fracture involving quadrilateral surface were treated with the calcaneal plate bridge reconstruction plate via the modified Stoppa approach.There were 12 males and 6 females.The age ranged from 28 to 63 years(mean,39 years).The cause of injury was traffic accident in 13 cases and falling from height in 5 cases.According to the Letournel-Judet classification,there were 10 cases of anterior and posterior column fractures,6 cases of T-shaped fractures,and 2 cases of anterior column and posterior semi-transevere fractures.The interval from injury to operation was6 to 24 days(mean,8.6 days).The reduction quality was assessed by postoperative X-ray film and CT according to the criteria proposed by Matta.The hip joint function was assessed by the modified Merled’Aubigné-Postel score.Results The operation time was 120-240 minutes(mean,165 minutes)and the intraoperative blood loss was 600-1400 mL(mean,850 mL).All patients were followed up 18-30 months(mean,24.5 months).There were 2 cases of the fat liquefaction of abdominal incisions,3 cases of intraoperative injury of lateral femoral cutaneous nerve,1 case of lower limb thrombosis,and 1 case of abdominal pain and hematuria due to intraoperative accidental bladder injury.According to the criteria proposed by Matta,the reduction quality rated as anatomic reduction in 12 cases,satisfactory reduction in5 cases,and unsatisfied reduction in 1 case,and the satisfaction rate was 94.4%.All fractures healed with the healing time of 3-5 months(mean,3.4 months).During follow-up,no internal fixator loosening,breakage,or fracture displacement occurred.At last follow-up,according to modified Merled’Aubigné-Postel score,hip joint functions rated as excellent in11 cases,good in 4 cases,fair in 2 cases,and poor in 1 case.The excellent and

关 键 词：髋臼骨折 方形区 改良STOPPA入路 跟骨钢板 重建钢板 内固定 

分 类 号：R687.3[医药卫生—骨科学]