經過了數日手術前的研究準備後，於2017/8/30上午，歷時3小時，成功完成了終身難得的挑戰-》從下腹橫切約15公分進入後骨盆腔，修復骨盆骨折。因為我將手術作到了傷害最小，達成了骨折復位固定良好的目標。我入行骨外科能在20幾年時，達到了這項成就，第一次有金盆洗手的念想了！
下圖：手術前的3DCT計畫圖和實際完成X光
下圖：中年男性左骨盆含髖臼粉碎性骨折手術治療，四個月後完全復原，蹲下完全可以。
Anterior Column and Posterior Hemitransverse Fractures of Acetabulum
Managed by ORIF Through Stoppa Approach – A Successful Case
經Stoppa路徑行開放式復位及內固定治療
前柱併後半橫斷型髖臼骨折−乙成功案例
劉國揚
烏日林新醫院創傷骨科主任
【Introduction】
The anterior column and posterior hemitransverse fractures of acetabulum is classified based on the cranial exit of the fracture in the ilium, with high fractures exiting above the iliac crest, intermediate fractures crossing between the spines, and low or very low fractures exit below the anterior inferior iliac spine. Thorough preoperative evaluation of the fracture will allow the majority of acetabular fractures to be managed through a single surgical approach. The important consideration is whether the posterior element is displaced. Many posterior fractures are not greatly displaced and can be treated by anterior approaches only, with either the modified Stoppa or ilioinguinal approach. A highly experienced and skilled surgeon may have the ability to do the surgery.
【Materials and Methods】
A 48 years old male was injured in motorcycle accident on August 25, 2017. The CT of pelvis showed moderately displaced anterior column with the cranial exit above the iliac crest and incomplete posterior hemitransverse fractures of left acetabulum. The left femoral head wasn’t displaced. There was no other associated injury. After well pre-operative planning, surgery was performed on August 30, 2017. During operation there was no tear of vessels and no blood transfusion. It took 3 hours for the operation. Most time was spent on the approach and applying the internal fixator while avoiding complications. A hemovac draining tube was inserted intrapelvicly before closing the wound. There was no incremental amount of daily drainage from the draining tube. Patient received physiotherapy of CPM exercise on bed. Weight bearing with walker support to right leg started one month post-operatively. Arthroscopic examination of left hip was performed on January 5, 2018.
【Results】
Two and a half months after operation patient felt no pain during bearing weight of left leg. Three months after operation patient was allowed to abandon walker. Four months post-operatively his gait was normal and he was able to squat fully. Left hip arthroscopy showed inflamed synovium and smooth contour of femoral head.
【Discussion】
Thorough understanding the Stoppa approach and associated anatomy was the key point to the successful surgery. Postoperative patient’s cooperation of protection of the reduction was another key point to the successful result. The moderately displaced anterior column with the cranial exit above the iliac crest and incomplete posterior hemitransverse fractures of acetabulum was absolutely better choosing Stoppa approach at surgical intervention.
