Ismail Hadisoebroto Dilogo, Djaja Yoshi Pratama, Fiolin Jessica
Department of Orthopaedic and Traumatology, Cipto Mangunkusumo Hospital - Faculty of Medicine Universitas Indonesia, Jl. Diponegoro no. 71, Jakarta Pusat, 10430, Indonesia.
J Clin Orthop Trauma. 2017 Jul-Sep;8(3):232-240. doi: 10.1016/j.jcot.2017.06.007. Epub 2017 Jun 8.
In performing surgery for fractures of the pelvis and acetabulum, various surgical approaches have been introduced with their own advantages and drawbacks. The extensile nature of ilioinguinal approach gives excellent exposure but was related to wound healing problems. Modified stoppa has a higher difficulty and poses a risk for neurovascular injury. In this study, we elaborate our experience using the Modified Stoppa approach with additional lateral window while adding few modifications to simplify the procedure and facilitate future implant removal.
A prospective-retrospective cohort involving 30 anterior pelvic ring and/or anterior column acetabulum fracture patients were conducted from 2012-2016. Fifteen cases were prospectively treated using the modified approach since 2014, while the remaining fifteen cases that were treated using Ilioinguinal approach were retrospectively reviewed. Intraoperative parameters such as blood loss, duration of surgery, quality of reduction (Matta) and postoperative functional outcome (Majeed and Hannover score) at 12 months period were recorded and evaluated by a blinded reviewer.
There were no significant differences between the two groups in mean age, sex and fracture type. The mean blood loss in the MIPO group were 325 ± 225 mL versus 710.67 ± 384.51 mL in the control group (p = 0.002). Duration of surgery were 149.33 ± 91.92 minutes in MIPO group versus 235.71 ± 65.79 minutes in ilioinguinal group (p = 0.014). There were no significant differences noted between the two groups in the quality of reduction and postoperative functional outcome, either by using Majeed or Hannover pelvic score. No complications were found after a 12-months follow up period. Two modified cases already had their implant removed and during the procedure, fibrotic tissue were minimal making the implant removal was less complicated and easier.
Modified stoppa and lateral window technique can be used as a safe and effective alternative approach for anterior pelvic ring fracture and/or anterior column acetabulum fracture. This approach decreased the duration of surgery and blood loss without compromising the quality of reduction and functional outcome in patients.
在进行骨盆和髋臼骨折手术时，已引入了各种手术入路，各有其优缺点。髂腹股沟入路的扩展性可提供极佳的暴露，但与伤口愈合问题相关。改良Stoppa入路难度较高，且存在神经血管损伤风险。在本研究中，我们阐述了使用改良Stoppa入路并增加外侧窗口的经验，同时进行了一些改进以简化手术过程并便于未来取出植入物。
对2012年至2016年期间的30例骨盆前环和/或髋臼前柱骨折患者进行了一项前瞻性-回顾性队列研究。自2014年起，对15例患者采用改良入路进行前瞻性治疗，同时对其余15例采用髂腹股沟入路治疗的患者进行回顾性分析。由一名盲法评估者记录并评估术中参数，如失血量、手术时间、复位质量（Matta评分）以及12个月时的术后功能结果（Majeed和汉诺威评分）。
两组在平均年龄、性别和骨折类型方面无显著差异。微创内固定治疗组的平均失血量为325±225毫升，而对照组为710.67±384.51毫升（p = 0.002）。微创内固定治疗组的手术时间为149.33±91.92分钟，髂腹股沟组为235.71±65.79分钟（p = 0.014）。使用Majeed或汉诺威骨盆评分评估，两组在复位质量和术后功能结果方面均无显著差异。随访12个月后未发现并发症。2例改良手术患者已取出植入物，手术过程中纤维化组织极少，使得植入物取出过程不那么复杂且更容易。
改良Stoppa和外侧窗口技术可作为骨盆前环骨折和/或髋臼前柱骨折的一种安全有效的替代入路。该入路缩短了手术时间和失血量，同时不影响患者的复位质量和功能结果。
