CAJ | 학술논문

目的探讨Stoppa入路的解剖要点及在骨盆前环骨折中的应用. 方法通过20具(40侧)教学尸体标本观察Corona mortis血管的出现率.通过骨盆正位X线片测量钢板在骨盆内侧壁进钉的安全区.回顾性分析2009年4月至2012年12月收治的22例骨盆前环骨折患者资料,男14例,女8例；平均年龄为32.6岁(17 ～56岁).单纯前环骨折16例,伴骶髂关节骨折脱位6例.骨折按Tile分型:A2型3例；B2型6例,B3型7例；C2型4例,C3型2例.均采用Stoppa入路手术治疗. 结果尸体标本观察Corona mortis血管的出现率为85.0％ (34/40).在真骨盆内侧缘,耻骨支区4孔钢板长度和邻近骶髂关节区3～4孔钢板长度进钉是安全的,髋臼区不能进钉.18例(81.8％)患者术中发现Corona mortis血管,均予以结扎.术后骨折复位质量根据Matta标准评定:解剖复位14例,良好复位7例,复位差1例,复位优良率为95.4％.19例患者术后获6～12个月(平均10.4个月)随访.19例患者骨折愈合时间为2～4个月,平均2.8个月.末次随访时骨盆功能按照Majeed评分标准评定:优12例,良5例,可2例. 结论解剖标本和临床观察Corona mortis血管的出现率均较高.应用Stoppa入路治疗骨盆前环骨折时能清晰地显示并方便处理Corona mortis血管,临床疗效良好.
목적 탐토Stoppa입로적해부요점급재골분전배골절중적응용. 방법 통과20구(40측)교학시체표본관찰Corona mortis혈관적출현솔.통과골분정위X선편측량강판재골분내측벽진정적안전구.회고성분석2009년4월지2012년12월수치적22례골분전배골절환자자료,남14례,녀8례；평균년령위32.6세(17 ～56세).단순전배골절16례,반저가관절골절탈위6례.골절안Tile분형:A2형3례；B2형6례,B3형7례；C2형4례,C3형2례.균채용Stoppa입로수술치료. 결과 시체표본관찰Corona mortis혈관적출현솔위85.0％ (34/40).재진골분내측연,치골지구4공강판장도화린근저가관절구3～4공강판장도진정시안전적,관구구불능진정.18례(81.8％)환자술중발현Corona mortis혈관,균여이결찰.술후골절복위질량근거Matta표준평정:해부복위14례,량호복위7례,복위차1례,복위우량솔위95.4％.19례환자술후획6～12개월(평균10.4개월)수방.19례환자골절유합시간위2～4개월,평균2.8개월.말차수방시골분공능안조Majeed평분표준평정:우12례,량5례,가2례. 결론 해부표본화림상관찰Corona mortis혈관적출현솔균교고.응용Stoppa입로치료골분전배골절시능청석지현시병방편처리Corona mortis혈관,림상료효량호.
Objective To study the clinical anatomy and application of Stoppa approach in fixation of pelvic anterior ring fractures.Methods The frequency of Corona Mortis in pelvis were observed in 20 cadavers (40 sides).The safe areas for screw insertion into the medial sidewall of the pelvis were measured in anteroposterior X-ray films of the pelvis.A retrospective study was performed of a series of 22 patients (14 males and 8 females) with pelvic anterior ring fracture who had been treated by Stoppa approach.They were 17 to 56 years of age (mean,32.6 years).Simple anterior ring fractures occurred in 16 patients who were fixated with plate of pelvic anterior ring.The other 6 cases were complicated with fracture dislocation of the sacroiliac articulation and treated with plate of pelvic anterior ring and sacroiliac screws.According to the Tile classification,3 fractures were type A2,6 type B2,7 type B3,4 type C2 and 2 type C3.Results The presence rate of Corona Mortis was 85.0％ (34/40) in the 20 cadavers.Of the inner margin of a true pelvis,the pubic branch district was safe for screw insertion of a 4-hole plate and the supra-acetabular region was also safe for screw insertion of a 3-4-hole plate,but the acetabular region was unsuitable for screw insertion of a 3-4-hole plate.The blood vessel,Corona Mortis,was found in 18 of the patients (18/22) and ligated in the operation.According to the Matta criteria,14 cases obtained anatomic reduction,7 good reduction and one poor reduction (the pelvic anterior ring fracture).Nineteen patients obtained follow-ups for 6 to 12 months (average,10.4 months) and all achieved bony union at 2.8 months postoperatively on average(range,2 to 4 months).At the last follow-up,the pelvic function was rated as excellent in 12,good in 5 and fair in 2 cases according to the Majeed evaluation system.Conclusions The presence of Corona Mortis is high by the cadaveric and clinical observations.Consequently,Stoppa approach is appropriate for internal fixation of an unstable pelvic ring fracture because it allows an adequate exposure for visualization and managernent of the vessel to achieve good clinical outcomes.