Anatomy Study Of Modified Medial Stoppa Approach To Pelvic And Acetabular Fracture And Its Clinical Use

Objective To study modified medial stoppa approach for acetabular fracture and its orthpeadic、nerve、vessel static structure to provides detailed anatomical parameters for surgery.To investigate the efficacy and clinical experience of the modified Stoppa approach to the treatment of acetabular fracture.Methods20adult hemipelvise specimens were dissected,measure its bone、nerve、vessel anatomical parameters. From January2010to August2012,10cases of acetabular fracture using a modified Stoppa approach to manage were analysed and summarized. By the Judet-Letournel typing:anterior and anterior column fracture in6cases,2cases of transverse fracture, double-column fracture in1, the anterior and the latter half of transverse fracture cases in1.A11of them underwent surgery,and all using a modified Stoppa approach and pelvic reconstruction plate and screw fixation. To evaluate clinical efficacy using Matta standard after operation.Results Mean length of obturator artery and vain are71.3±4.6mm and75±2.1mm, The distance from the obturator canal entrance of obturator artery and vein to linea terminalis are20.5±1.4mm and21±2mm, The distance from the root of obturator artery and vein to linea terminalis are14.5±0.8mm and25.4±3.1mm, The distance from the midpoint of obturator artery and vein to linea terminalis are18.1±2.3mm and30±1.5mm, The distance of obturator nerve at the obturator canal entrance to linea terminalis is20.2±1.8mm, The distance from the intersection point of obturator nerve and linea terminalis to sacroiliac joint is10.6±2.9mm.The distance from corona mortis to pubic symphysis is49±3.6mm.The variation rate of conora mortis is55%. The distance from projection of the acetabular on pelvis boundary line to iliopubic eminence is anteriorly15mm, posteriorly35mm.The Stoppa approach incision length is10cm-15cm, an average of12cm, Operative time was90-140minutes, with an average of110minutes, blood loss was250-500ml, average380ml. The postoperative evaluation based on Matta standards:eight cases satisfactory reduction,2cases are good.10patients were followed up after operation, All patients were available full weight bearing walking after3months of operation. The average fracture healing time was4.5months.Conclusion Before clinical applying modified medial stoppa approach to treat acetabular fracture,cadaver dissection is important to minimize surgical risk.In the study,we obtain orthpeadic、nerve、vessel structure measurement data of pelvic medial wall,which will provide reliable anatomical data for carrying out modified medial stoppa approach to treatment of acetabular and pelvic fractures. The modified Stoppa approach is an ideal surgical approach for treatment of acetabular fractures,and also is an effective alternative approach to ilioinguinal approach.