中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
11期
1245-1249
,共5页
陈晓东%崔一民%沈超%朱俊峰%吴冰2%宋煊3
陳曉東%崔一民%瀋超%硃俊峰%吳冰2%宋煊3
진효동%최일민%침초%주준봉%오빙2%송훤3
髋臼%骨折%外科手术
髖臼%骨摺%外科手術
관구%골절%외과수술
Acetabulum,Fractures,bone%Surgical procedures,operative
目的 探讨Stoppa入路治疗髋臼骨折的手术方法及初步临床效果.方法 2005年5月至2010年5月,应用Stoppa入路治疗髋臼骨折23例,男17例,女6例;年龄21~71岁,平均37岁;车祸伤14例,坠落伤7例,跌倒摔伤2例.髋臼骨折按Letournel分型:前柱骨折7例,前柱加后半横行骨折6例,横行骨折6例,双柱骨折4例.患者均采用Stoppa入路手术,4例双柱骨折及4例前柱加后半横行骨折患者附加外侧切口.结果 23例患者手术时间为110~320 min,平均166 min;术中失血量为300~2500 ml,平均647 ml;输红细胞0~12个单位,平均3.3个单位.术后3个月所有骨折均愈合.所有患者均获得随访,随访时间12~36个月,平均20个月.依据Matta髋臼骨折复位标准,优15例(65%),良5例(22%),差3例(13%);优良率为87%.根据Matta改良的Merle d'Aubigne和Postel髋关节功能评分标准,优11例(48%),良7例(30%),可3例(13%),差2例(9%);优良率为78%.术后1例患者发生伤口浅表感染,经清创后愈合;1例因牵拉闭孔神经致股内收肌肌力下降,1年后恢复至4级.末次随访时,无一例发生坐骨神经、股神经以及主要血管损伤,亦未出现与切口相关的其他并发症.结论对于具有适应证的髋臼骨折患者,Stoppa入路不但可以获得满意的显露,而且便于骨折复位和内固定,特别是对伴股骨头中心性脱位及髋臼内壁内移明显者具有一定的优势.
目的 探討Stoppa入路治療髖臼骨摺的手術方法及初步臨床效果.方法 2005年5月至2010年5月,應用Stoppa入路治療髖臼骨摺23例,男17例,女6例;年齡21~71歲,平均37歲;車禍傷14例,墜落傷7例,跌倒摔傷2例.髖臼骨摺按Letournel分型:前柱骨摺7例,前柱加後半橫行骨摺6例,橫行骨摺6例,雙柱骨摺4例.患者均採用Stoppa入路手術,4例雙柱骨摺及4例前柱加後半橫行骨摺患者附加外側切口.結果 23例患者手術時間為110~320 min,平均166 min;術中失血量為300~2500 ml,平均647 ml;輸紅細胞0~12箇單位,平均3.3箇單位.術後3箇月所有骨摺均愈閤.所有患者均穫得隨訪,隨訪時間12~36箇月,平均20箇月.依據Matta髖臼骨摺複位標準,優15例(65%),良5例(22%),差3例(13%);優良率為87%.根據Matta改良的Merle d'Aubigne和Postel髖關節功能評分標準,優11例(48%),良7例(30%),可3例(13%),差2例(9%);優良率為78%.術後1例患者髮生傷口淺錶感染,經清創後愈閤;1例因牽拉閉孔神經緻股內收肌肌力下降,1年後恢複至4級.末次隨訪時,無一例髮生坐骨神經、股神經以及主要血管損傷,亦未齣現與切口相關的其他併髮癥.結論對于具有適應證的髖臼骨摺患者,Stoppa入路不但可以穫得滿意的顯露,而且便于骨摺複位和內固定,特彆是對伴股骨頭中心性脫位及髖臼內壁內移明顯者具有一定的優勢.
목적 탐토Stoppa입로치료관구골절적수술방법급초보림상효과.방법 2005년5월지2010년5월,응용Stoppa입로치료관구골절23례,남17례,녀6례;년령21~71세,평균37세;차화상14례,추락상7례,질도솔상2례.관구골절안Letournel분형:전주골절7례,전주가후반횡행골절6례,횡행골절6례,쌍주골절4례.환자균채용Stoppa입로수술,4례쌍주골절급4례전주가후반횡행골절환자부가외측절구.결과 23례환자수술시간위110~320 min,평균166 min;술중실혈량위300~2500 ml,평균647 ml;수홍세포0~12개단위,평균3.3개단위.술후3개월소유골절균유합.소유환자균획득수방,수방시간12~36개월,평균20개월.의거Matta관구골절복위표준,우15례(65%),량5례(22%),차3례(13%);우량솔위87%.근거Matta개량적Merle d'Aubigne화Postel관관절공능평분표준,우11례(48%),량7례(30%),가3례(13%),차2례(9%);우량솔위78%.술후1례환자발생상구천표감염,경청창후유합;1례인견랍폐공신경치고내수기기력하강,1년후회복지4급.말차수방시,무일례발생좌골신경、고신경이급주요혈관손상,역미출현여절구상관적기타병발증.결론대우구유괄응증적관구골절환자,Stoppa입로불단가이획득만의적현로,이차편우골절복위화내고정,특별시대반고골두중심성탈위급관구내벽내이명현자구유일정적우세.
Objective To report the preliminary results and surgical technique of Stoppa approach used in treatment of acetabular fracture.Methods From May 2005 to May 2010,23 patients with acetabular fracture were treated using modified Stoppa approach.The mean age was 37 years old (range,21-71years old).According to Letournel classification,there were 7 cases in anterior column fracture,6 cases in anterior column with posterior hemitransverse fracture,6 cases in transverse fracture,4 cases in associated with both column fractures.All patients in the study were operated under general anesthesia on a radiolucent table in a supine position and underwent Stoppa approach.Fracture reduction was evaluated by Matta's score system.The clinical outcome was judged by modified Merle d' Aubigne and Postel score system.Four cases of associated both column fractures,4 cases of anterior column with posterior hemitransverse fracture required the use of the lateral window.Results The mean surgical time was 166 min (range,110-320 min).The mean blood lose was 647 ml (range,300-2500 ml).Blood transfusion was 3.3 unites (0-12 unites).All the factures healed in 3 months.The fracture reduction was evaluated according to the Matta's score system:an excellent reduction was obtained in 15 patients(65%),a good reduction was obtained in 5 patients (22%),and three (13%) were considered poor.Clinical results were excellent in 11 patients (48%),good in 7 patients (30%),fair in 3 patient (13%),and poor in 2 patients (9%).Superficial wound infection happened in 1 case.It healed after debridment.One patient noted to have significant weakness of the hip adductors (obturator nerve palsy) after surgery.It reached grade Ⅳ one year later.No sciatic nerve,femoral nerve and vascular injury happened in this study.Conclusion For the selected acetabualar fracture,Stoppa approach can get satisfied exposure and fixation of the fracture,especially in the patient with central dislocation of the femoral head as well as medial displacement of quadrilateral plate.