髋臼骨折手术治疗的改良Stoppa入路与髂腹股沟入路疗效对比

发布时间：2018-06-01 17:52

本文选题：髋臼骨折 + 改良Stoppa入路　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:比较髋臼骨折手术治疗中改良Stoppa入路与髂腹股沟入路的临床疗效。方法:回顾性分析2011年1月至2016年8月期间,在福建省立医院采用前方手术入路治疗的髋臼骨折临床资料,共有34例,男22例,女12例,年龄25—66岁,平均46.0岁。采用改良Stoppa入路治疗为A组,共16例,其中以左侧髂前切口为辅助入路1例,联合髂脊切口固定髂骨翼7例;采用髂腹股沟入路治疗,共18例,从中随机抽取16例为B组,其中联合K-L入路固定后柱或后壁4例,联合髂脊切口固定髂骨翼1例,联合臀后切口固定骶髂关节1例。两组患者的性别、年龄、致伤因素、Letournel分型、合并伤、受伤后到手术时间等一般资料之间,差异均不具有统计学意义(P0.05)。通过对比两组的切口长度、手术时间、术中出血量、术后引流量、X线Matta评分、术后第3、6、9个月的髋关节Harris评分来评价治疗效果。结果:1、两组手术时间、术中出血量、术后引流量以及在院时间,差异不具有统计学意义(P0.05)。2、改良Stoppa入路组的切口长度显著短于髂腹股沟入路组,差异具有统计学意义(P0.05)。3、比较两组术后影像学Matta评分,差异不具有统计意义(P0.05),但改良Stoppa入路组的复位满意率高于髂腹股沟入路组。4、两组术后第3、6、9月的Harris评分之间,差异不具有统计意义(P0.05),但是术后6、9月改良Stoppa入路组的良好率明显高于髂腹股沟入路组。两组Harris疼痛评分之间,差异均没有统计学意义(P0.05)。5、术后并发症:改良Stoppa入路组术后近期出现切口感染1例、切口脂肪液化1例,远期未出现并发症;髂腹股沟入路组近期无并发症,远期出现创伤性关节炎1例、股骨头缺血性坏死1例。结论:1、应用改良Stoppa入路和髂腹股沟入路治疗髋臼骨折,都能够达到良好的临床疗效。2、在治疗髋臼骨折中,改良Stoppa入路与经典的髂腹股沟入路相比,具有手术切口小,邻近组织损伤小,暴露良好,能直视四边体,骨折复位精确质量可靠,术后关节功能恢复良好,创伤性关节炎发病少等优点。
[Abstract]:Objective: to compare the clinical effects of modified Stoppa approach and ilioinguinal approach in the treatment of acetabular fractures. Methods: from January 2011 to August 2016, 34 cases of acetabular fractures, 22 males and 12 females, aged 25-66 years (mean 46.0 years), were treated by anterior surgical approach in Fujian Provincial Hospital. 16 cases were treated with modified Stoppa approach, including 1 case with left anterior iliac incision, 7 cases with iliac pterygoid fixed by combined iliac spine incision, 18 cases treated by ilioinguinal approach, 16 cases were randomly selected as group B. The posterior column or posterior wall was fixed by combined K-L approach in 4 cases, iliac pterygoid was fixed with iliac spine incision in 1 case, sacroiliac joint was fixed with posterior buttock incision in 1 case. There was no significant difference between the two groups in terms of sex, age, cause factors of injury and Letournel classification, combined injury, and the time from injury to operation, etc. There was no significant difference between the two groups (P 0.05). The treatment effect was evaluated by comparing the incision length, operation time, intraoperative bleeding volume, postoperative drainage volume and X-ray Matta score, and the hip joint Harris score at the 3rd month and 9th month after operation. Results there was no significant difference in operative time, intraoperative bleeding volume, postoperative drainage volume and hospital time between the two groups. The length of incision in the modified Stoppa approach group was significantly shorter than that in the ilioinguinal approach group. The difference was statistically significant (P 0.05). There was no significant difference in Matta scores between the two groups, but the satisfaction rate of the modified Stoppa approach group was higher than that of the ilioinguinal approach group. The Harris scores of the two groups were higher than those of the ilioinguinal approach group, and the Harris scores of the 6th and 9th months after operation were higher in the modified Stoppa approach group than in the ilioinguinal approach group. The difference was not statistically significant, but the good rate of modified Stoppa approach group was significantly higher than that of ilioinguinal approach group 6 and 9 months after operation. There was no significant difference in Harris pain score between the two groups. The postoperative complications were as follows: in the modified Stoppa approach group, incision infection occurred in 1 case, incision fat liquefaction in 1 case, and there was no complication in the long term. In the ilioinguinal approach group, there were no complications, 1 case with traumatic arthritis and 1 case with avascular necrosis of femoral head. Conclusion the modified Stoppa approach and ilioinguinal approach are effective in the treatment of acetabular fractures. In the treatment of acetabular fractures, the modified Stoppa approach has a smaller operative incision than the classical ilioinguinal approach. The adjacent tissues have the advantages of small injury, good exposure, direct view of the quadrilateral body, accurate and reliable reduction of fracture, good recovery of joint function after operation, less incidence of traumatic arthritis and so on.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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