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Title: [TREATMENT OF ACETABULAR ANTERIOR AND POSTERIOR COLUMN FRACTURES BY MODIFIED Stoppa APPROACH].
Author: Li D, Fang Y, Zou C, Huang F, Liu L, Xiang Z, Yang T.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2016 Nov 08; 30(11):1344-1348. PubMed ID: 29786383.
Abstract:
OBJECTIVE: To evaluate the surgical techniques, perioperative complications, clinical outcomes of the modified Stoppa approach in the treatment of acetabular anterior and posterior column fractures. METHODS: Between March 2008 and October 2014, 42 cases of acetabular anterior and posterior column fractures were treated by modified Stoppa approach or modified Stoppa approach combined with iliac fossa approach, and the clinical data were retrospectively analyzed. There were 20 females and 22 males with an average age of 43.2 years (range, 19-68 years). Fractures were caused by traffic accident in 21 cases, by falling from height in 16 cases, and by heavy pound in 5 cases. The time from injury to operation was 3-15 days (mean, 6 days). According to fracture classification of Letournel-Judet, there were 20 cases of both column fractures, 15 cases of anterior and posterior hemi-transverse fractures and 7 cases of T-shaped fractures. The intraoperative blood loss, the amount of blood transfusion, the operation time, the volumn of drainage, and complication were recorded. Matta radiological standard was used to evaluate the reduction quality of fracture, and Merled'Aubigné-Postel system to evaluate hip function. RESULTS: The average intraoperative blood loss was 900 mL; the average amount of blood transfusion was 400 mL; the average volume of drainage was 110 mL; and the average operation time was 165 minutes. Intraoperative complications included 4 cases of tractive injury of obturator nerve and 2 cases of the external iliac vein injury, and postoperative complications included 2 cases of lateral femoral cutaneous nerve palsies and 1 case of deep vein embolism of lower extremity, which were improved after treatment. The patients were followed up 36 months on average (range, 12-48 months). There was no infection or heterotopic ossification. According to Matta radiological evaluation system, the reduction quality of fractures was rated as excellent in 21 cases, good in 16 cases, and poor in 5 cases, with an excellent and good rate of 88.1%. The healing time of fracture was 3.5-8.0 months (mean, 5.1 months). According to Merled'Aubigné-Postel system for hip function, 20 cases were graded as excellent, 15 cases as good, 4 cases as fair, and 3 cases as poor, with an excellent and good rate of 83.3% at last follow-up. CONCLUSIONS: Modified Stoppa approach or with iliac fossa approach can get full exposure of quadrilateral area, good reduction, and firm internal fixation in the treatment of acetabular fractures associated with T-shaped fractures, both column fractures, anterior and posterior hemi-transverse fractures. 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 mL，平均输血量400 mL，平均引流量110 mL，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。.

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