单一改良Stoppa入路内固定治疗髋关节中心性脱位合并髋臼后壁骨折的疗效分析  

Internal fixation via only the modified Stoppa approach for central hip dislocation complicated with fracture of the posterior acetabular wall

作　　者：杨运平[1] 钟红发 胡稷杰[1] 钟子毅 许道荣[1] 曹生鲁 王钢[1] Yang Yunping;Zhong Hongfa;Hu Jijie;Zhong Ziyi;Xu Daorong;Cao Shenglu;Wang Gang(Department of Orthopedic Trauma,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;Trauma Center,Ganzhou Hospital,Nanfang Hospital,Ganzhou 341000,China)

机构地区：[1]南方医科大学南方医院骨科-创伤骨科,广州510515 [2]南方医院赣州医院创伤中心,赣州341000

出　　处：《中华创伤骨科杂志》2022年第5期409-413,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨单一改良Stoppa入路内固定治疗髋关节中心性脱位合并髋臼后壁骨折的疗效。方法回顾性分析2015年2月至2018年2月间南方医科大学南方医院骨科-创伤骨科收治的13例髋关节中心性脱位合并髋臼后壁骨折患者资料。男10例, 女3例;年龄31~65岁, 平均46.7岁。所有患者均采用单一改良Stoppa入路内固定治疗。术后即刻依据Matta评分系统评估双柱及后壁骨折的复位情况, 测量正常侧及术后患侧髋关节股骨头中心点的垂线与髋臼外侧边缘的夹角(CE角)及股骨头包容度变化情况, 以评价骨折复位效果;术后12个月采用改良的Merle d’Aubigne和Postel评分系统评价患侧髋关节功能。结果 13例患者术后获16~52个月(平均25.6个月)随访。所有患者均顺利完成髋关节中心性脱位和髋臼骨折的复位固定, 后壁骨折间接复位满意, 髋臼包容度满意。手术时间为130~270 min, 平均155.5 min;术中出血量为600~5 600 mL(平均1 150.5 mL);术中输注浓缩红细胞平均6 U(2~12 U)。术后即刻根据X线片按Matta标准评估复位质量:髋臼后壁骨折解剖复位4例, 满意复位9例。根据术后即刻X线片, 患侧髋关节CE角(43.53°±3.46°)与正常侧(43.19°±3.28°)比较差异无统计学意义(P>0.05);患侧股骨头包容度(76.56%±15.50%)与正常侧(75.32%±16.24%)比较差异无统计学意义(P>0.05)。术后12个月改良Merle d’Aubigne和Postel评分为12~18分, 平均16.5分;其中髋关节功能优9例, 良3例, 一般1例。末次随访时13例患者骨折复位均未丢失, 骨折内固定牢固, 无一例患者发生内固定物松动、断裂。结论采用单一改良Stoppa入路内固定治疗髋关节中心性脱位合并髋臼后壁骨折, 可达到骨折复位满意、髋关节包容性好的目的, 疗效较好。Objective To evaluate internal fixation via only the modified Stoppa approach in the treatment of central hip dislocation complicated with fracture of the posterior acetabular wall.Methods A retrospective study was conducted in the 13 patients with central hip dislocation and fracture of the posterior acetabular wall who had been treated at Department of Orthopedic Trauma,Nanfang Hospital between February 2015 and February 2018.They were 10 men and 3 women,aged from 31 to 65 years(average,46.7 years).All patients were treated with internal fixation via only the modified Stoppa approach.The reduction of double-column and posterior wall fractures was evaluated according to the X-ray Matta scoring system,as well as to the Wiberg central-edge(CE)angles between the vertical line of the center point of the femoral head and the lateral edge of the acetabulum and acetabular tolerance on the normal and affected sides immediately after operation;the hip function was evaluated by the modified Merle d'Aubigne and Postel scoring system at 12 months after operation.Results All patients were followed up for 16 to 52 months(average,25.6 months).In all of them,reduction and fixation of central hip dislocation and acetabular fracture was completed successfully,and indirect reduction of posterior wall fracture and acetabular tolerance were satisfactory.Operation time ranged from 130 to 270 min,averaging 155.5 min;intraoperative blood loss from 600 to 5,600 mL,averaging 1,150.5 mL;intraoperative infusion of concentrated red blood cells from 2 to 12 U,averaging 6 U.By the X-ray Matta scoring system immediately after operation,anatomical reduction was achieved in 4 posterior wall fractures and satisfactory reduction in 9 ones.There was no significant difference between the normal and affected sides in the CE angle(43.53°±3.46°for the affected side versus 43.19°±3.28°for the normal side)or in the acetabular tolerance(76.56%±15.50%for the affected side versus 75.32%±16.24%for the normal side)(P>0.05).The modified Merle d'Aubigne

关 键 词：髋关节 髋脱位 髋臼 中心性脱位 后壁骨折 改良STOPPA入路 

分 类 号：R687.3[医药卫生—骨科学]