本文選題：髖臼骨折 + 內(nèi)固定��； 參考：《中國(guó)修復(fù)重建外科雜志》2016年11期

【摘要】：目的探討改良Stoppa入路治療髖臼前后柱骨折的手術(shù)方法、圍術(shù)期并發(fā)癥和臨床療效。方法回顧分析2008年3月-2014年10月采用改良Stoppa入路或改良Stoppa聯(lián)合髂腹股溝入路外側(cè)窗(髂窩入路)治療的42例髖臼前后柱骨折患者資料。男22例,女20例;年齡19~68歲,平均43.2歲。致傷原因:交通事故傷21例,高處墜落傷16例,重物砸傷5例。受傷至手術(shù)時(shí)間為3~15 d,平均6 d。根據(jù)Letournel-Judet分型:雙柱骨折20例,前加后半橫行骨折15例,T形骨折7例。記錄術(shù)中出血量、輸血量、手術(shù)時(shí)間、術(shù)后引流量及并發(fā)癥情況等。采用Matta影像學(xué)標(biāo)準(zhǔn)評(píng)定骨折復(fù)位質(zhì)量,末次隨訪時(shí)采用Merled’Aubigné-Postel標(biāo)準(zhǔn)評(píng)定髖關(guān)節(jié)功能。結(jié)果患者術(shù)中平均出血量900 m L,平均輸血量400 m L,平均引流量110 m L,平均手術(shù)時(shí)間165 min。術(shù)中發(fā)生4例閉孔神經(jīng)牽拉傷,2例髂外靜脈損傷;術(shù)后出現(xiàn)1例下肢深靜脈血栓形成,2例股外側(cè)皮神經(jīng)麻痹,經(jīng)積極治療后均恢復(fù)良好。42例均獲隨訪,隨訪時(shí)間12~48個(gè)月,平均36個(gè)月。無一例患者出現(xiàn)感染、異位骨化等其他并發(fā)癥。術(shù)后骨折復(fù)位質(zhì)量根據(jù)Matta影像學(xué)標(biāo)準(zhǔn)評(píng)定:優(yōu)21例,良16例,差5例,優(yōu)良率88.1%。根據(jù)X線片及臨床表現(xiàn)判定髖臼骨折愈合時(shí)間為3.5~8.0個(gè)月,平均5.1個(gè)月。末次隨訪時(shí)髖關(guān)節(jié)功能根據(jù)Merled’Aubigné-Postel標(biāo)準(zhǔn)評(píng)定:優(yōu)20例,良15例,可4例,差3例,優(yōu)良率為83.3%。結(jié)論采用改良Stoppa入路或聯(lián)合髂窩入路治療大部分雙柱、T形及前加后半橫行骨折,能在直視下顯露髖臼四方體,并易于在真骨盆緣以下放置支撐鋼板對(duì)骨折進(jìn)行堅(jiān)強(qiáng)內(nèi)固定,從而利于患者快速康復(fù)。
[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.
【作者單位】： 四川大學(xué)華西醫(yī)院骨科;
【分類號(hào)】：R687.3

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