改良Stoppa入路治疗髋臼前后柱骨折疗效分析

发布时间：2018-07-11 11:07

本文选题：髋臼骨折 + 内固定　；参考：《中国修复重建外科杂志》2016年11期

【摘要】：目的探讨改良Stoppa入路治疗髋臼前后柱骨折的手术方法、围术期并发症和临床疗效。方法回顾分析2008年3月-2014年10月采用改良Stoppa入路或改良Stoppa联合髂腹股沟入路外侧窗(髂窝入路)治疗的42例髋臼前后柱骨折患者资料。男22例,女20例;年龄19~68岁,平均43.2岁。致伤原因:交通事故伤21例,高处坠落伤16例,重物砸伤5例。受伤至手术时间为3~15 d,平均6 d。根据Letournel-Judet分型:双柱骨折20例,前加后半横行骨折15例,T形骨折7例。记录术中出血量、输血量、手术时间、术后引流量及并发症情况等。采用Matta影像学标准评定骨折复位质量,末次随访时采用Merled’Aubigné-Postel标准评定髋关节功能。结果患者术中平均出血量900 m L,平均输血量400 m L,平均引流量110 m L,平均手术时间165 min。术中发生4例闭孔神经牵拉伤,2例髂外静脉损伤;术后出现1例下肢深静脉血栓形成,2例股外侧皮神经麻痹,经积极治疗后均恢复良好。42例均获随访,随访时间12~48个月,平均36个月。无一例患者出现感染、异位骨化等其他并发症。术后骨折复位质量根据Matta影像学标准评定:优21例,良16例,差5例,优良率88.1%。根据X线片及临床表现判定髋臼骨折愈合时间为3.5~8.0个月,平均5.1个月。末次随访时髋关节功能根据Merled’Aubigné-Postel标准评定:优20例,良15例,可4例,差3例,优良率为83.3%。结论采用改良Stoppa入路或联合髂窝入路治疗大部分双柱、T形及前加后半横行骨折,能在直视下显露髋臼四方体,并易于在真骨盆缘以下放置支撑钢板对骨折进行坚强内固定,从而利于患者快速康复。
[Abstract]:Objective to explore the operative method, perioperative complications and clinical effect of modified Stoppa approach for the treatment of anterior and posterior column fractures of acetabulum. Methods from March 2008 to October 2014, 42 patients with anterior and posterior column fractures of acetabulum were treated with modified Stoppa approach or modified Stoppa combined with ilioinguinal approach (iliac fossa approach). There were 22 males and 20 females with an average age of 43.2 years (1968 years). The causes of injury were: 21 cases of traffic accident, 16 cases of falling injury and 5 cases of heavy object injury. The time from injury to operation was 3 to 15 days, with an average of 6 days. According to Letournel-Judet classification, there were 20 cases of double column fractures, 15 cases of anterior and posterior half transverse fractures and 7 cases of T-shaped fractures. Blood loss, blood transfusion, operation time, postoperative drainage and complications were recorded. The quality of fracture reduction was evaluated by Matta imaging standard, and the hip function was evaluated by Merledine Aubign 茅 -Postel standard at the last follow-up. Results the average blood loss during operation was 900 mL, the average blood transfusion was 400 mL, the average drainage volume was 110 mL, and the average operation time was 165 min. There were 4 cases of obturator nerve traction injury in 2 cases of external iliac vein injury, 1 case of deep vein thrombosis of lower extremity and 2 cases of lateral femoral cutaneous nerve palsy after operation. All cases were followed up after active treatment. The follow-up time was 12 ~ 48 months. An average of 36 months. Infection, ectopic ossification and other complications were not found in any of the patients. The quality of postoperative fracture reduction was evaluated according to Matta imaging criteria: excellent 21 cases, good 16 cases, poor 5 cases, excellent and good rate 88.1. The healing time of acetabular fracture was 3. 5 ~ 8. 0 months (mean 5. 1 months) according to X-ray film and clinical manifestation. At the last follow-up, the hip joint function was assessed according to Merledn Aubign 茅 -Postel standard: excellent 20 cases, good 15 cases, fair 4 cases, poor 3 cases, excellent and good rate 83.3%. Conclusion the modified Stoppa approach or the combined iliac fossa approach for the treatment of most of the double column T-shaped and anterior plus posterior half transverse fractures can expose the acetabular tetragonal body under direct vision, and it is easy to place a supporting plate below the true pelvic margin to make a strong internal fixation of the fracture. Thus, it is beneficial to the patient's rapid recovery.
【作者单位】：四川大学华西医院骨科;
【分类号】：R687.3

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