应用MIPO技术治疗骨盆与髋臼前柱骨折

发布时间：2018-04-28 03:20

本文选题：MIPO技术 + 髋臼　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:比较应用MIPO技术与传统的髂腹股沟入路手术治疗骨盆与髋臼骨折的疗效。方法:回顾性分析2013年1月-2014年12月在我科治疗的23例骨盆与髋臼骨折患者的临床资料,男性17例,女性6例,年龄25~62岁,平均年龄(44.17±9.69)岁。致伤因素:交通伤15例,坠落伤6例,挤压伤2例。23例患者中,伴有多发伤10例,其中8例合并后环骨折,4例合并四肢骨折,3例合并胸腹部脏器损伤,2例合并尿道损伤,2例合并颅脑损伤。受伤至手术时间为3-15天,平均为(8.50±3.64)天。将23例患者分成A、B两组,A组应用MIPO技术治疗的患者共11例,其中男性9例,女性2例,年龄33~61岁,平均年龄(42.82±8.17)岁,骨盆骨折4例,按Young-Burgess分型:APCⅢ型1例,LCⅡ型3例。髋臼骨折骨折7例,按Judet-Letournel分型:双柱骨折4例,T型骨折2例,横行骨折1例。治疗方法:于患者髂骨和同侧的耻骨上方分别做切口,先将移位的髂骨和髋臼前柱复位并用克氏针或螺钉行临时固定,然后将钢板从髂骨切口穿入,经髂腰肌和髂血管的下方于耻骨上方的切口穿出(或者于耻骨上方的切口穿入,经髂腰肌和髂血管的下方,然后在髂骨切口穿出),再将骨盆与髋臼的骨折进行固定。7例髋臼骨折中,3例患者附加Kocher-Langen-beck入路复位并固定髋臼后柱骨折;B组应用传统的髂腹股沟入路手术治疗的患者共计12例,其中男性8例,女性4例,年龄25~62岁,平均年龄(45.42±11.13)岁;骨盆骨折4例,按Young-Burgess分型:APCⅢ型1例,LCⅡ型1例,LCⅢ型2例。髋臼骨折骨折8例,按Judet-Letournel分型:双柱骨折3例,T型骨折4例,横行骨折1例。治疗方法:采用经典的髂腹股沟入路,需要游离髂腰肌、髂血管和精索(子宫圆韧带),暴露“三个窗口”再将骨折进行复位,然后在直视下将钢板从髂腰肌和髂血管下穿过,并从耻骨联合上切口穿出,固定骨盆和髋臼前柱骨折。8例髋臼骨折的患者中,4例患者附加Kocher-Langenbeck入路复位并固定髋臼后柱骨折;记录两组组患者的手术时间、术中出血量、术后引流量、术后功能及术后并发症发生情况。术后骨盆骨折及髋臼骨折用Matta复位标准评定骨折复位的质量。末次随访时采用改良的Merle D'Aubigne-Postel评分系统评定髋关节的功能。结果:⑴手术时间:A组为90~360min(不包括后环及其它部位骨折固定的时间),平均(171±81.6)min,B组为180~480min,平均为(293.4±96)min,A组的手术时间少于B组,差异有统计学意义,(P0.05);⑵术中出血量:A组为270~2000ml(不包括其它部位骨折固定的),平均(128.33±44.38)ml,B组为400~3000ml,平均(501.82±177.36)ml,A组的术中出血量少于B组,差异有统计学意义,(P0.05);⑶术后引流量:A组为20~150ml(不包括其它部位骨折固定的),平均(51.82±43.09)ml,B组为30~200ml,平均(105.83±47.19)ml,A组的术后引流量少于B组,差异有统计学意义,(P0.05);⑷骨折的复位质量:A组骨盆骨折中复位满意4例,复位不满意0例,髋臼骨折中解剖复位3例,复位良好4例,复位差0例。B组骨盆骨折中复位满意3例,复位不满意1例,髋臼骨折中复位解剖复位5例,复位良好2例,复位差1例;⑸髋关节功能评分:A组优3例,良好6例,可2例,差0例,B组优3例,良好7例,可1例,差1例。二者的骨折复位质量及末次随访的髋关节功能相比,无统计学意义,(P0.05);A组患者术后1例出现股外侧皮神经的症状,1例出现伤口浅表感染;B组患者术后2例出现股外侧皮神经损伤的症状,1例出现尿路感染,2例出现伤口浅表感染,1例出现股浅静脉血栓,1例出现异位骨化。术后均未出现骨折不愈合、髋臼感染等并发症;A组与B组相比,其术后并发症较少,有统计学意义(P0.05)结论:应用MIPO技术治疗骨盆与髋臼前柱骨折创伤小、出血少、手术时间短、安全性高并可以不显露股血管及股神经等优点。
[Abstract]:Objective: To compare the efficacy of MIPO and traditional iliac inguinal approach in the treatment of pelvic and acetabular fractures. Methods: a retrospective analysis of the clinical data of 23 patients with pelvic and acetabular fractures in December January 2013, -2014, in our department, 17 males, 6 women, age 25 ~62 years, average age (44.17 + 9.69) years. There were 15 cases of injury, 6 cases of falling injury, 2 cases of.23 and 10 cases of multiple injuries, of which 8 cases were combined with posterior ring fracture, 4 cases with limbs fracture, 3 cases with thoracic and abdominal organ injury, 2 cases with urethral injury, 2 cases with craniocerebral injury. The operation time was 3-15 days, the average was (8.50 + 3.64) days. The patients were divided into A, B two group, A group. 11 patients were treated with MIPO, including 9 males, 2 females, age 33~61, average age (42.82 + 8.17) years, 4 pelvic fractures, 1 cases of APC III, 3 of LC type II, 7 fracture of the acetabular fracture, 4 cases of double column fractures, 2 cases of T type fractures and 1 cases of transverse fractures. The iliac bone and the same side of the pubis are cut through the ilium and the anterior column of the acetabulum and temporarily fixed with Kirschner's pin or screw. Then the plate is penetrated through the iliac incision and through the incision above the pubis (or the incision on the suprapubic side) below the ilium and iliac vessels (or through the upper part of the pubis, below the ilium and iliac vessels. And then in the iliac incision, and then the pelvic and acetabular fractures were fixed for the.7 fracture of the acetabulum, 3 patients were added to the Kocher-Langen-beck approach and fixed the posterior column fracture; in group B, 12 patients were treated with traditional iliac inguinal approach, of which 8 were male, 4 women, age 25~62 years (45.42). 11.13 years of age, 4 cases of pelvic fracture, according to Young-Burgess type: 1 cases of type APC III, 1 cases of LC type II, 2 cases of type LC III, 8 cases of acetabular fracture, 3 cases of double column fracture, 4 cases of type fracture, 1 cases of transverse fracture. Treatment method: the treatment method: the iliocsoas muscle, iliac blood vessel and spermatic cord (round ligament), and the classical iliac inguinal approach were used. "Three windows" reposition the fracture and then cross the plate under the iliocsoas and iliac blood vessels under direct vision, through the joint incision of the pubis, and in the patients with the fracture of the acetabular fracture of the pelvis and the anterior column of the acetabulum in.8, 4 cases are attached and fixed the posterior column fracture of the acetabulum, and the two groups of patients are recorded. The operation time, intraoperative bleeding, postoperative flow rate, postoperative function and postoperative complications. Pelvic fracture and acetabular fracture were evaluated by Matta reduction criteria. The modified Merle D'Aubigne-Postel scoring system was used to evaluate the function of the hip joint during the last follow-up. Results: (1) the operation time: group A was 90~360mi N (171 + 81.6) min, group B was 180~480min, and group B was (293.4 + 96) min, and the operation time of group A was less than that of group B (P0.05); (2) the amount of bleeding in the operation: A group was 270~2000ml (not included in other parts of fracture), average (128.33 + 44.38) ml, B group was, Mean (501.82 + 177.36) ml, the amount of bleeding in group A was less than that in group B, the difference was statistically significant (P0.05); (3) postoperative flow rate: A group was 20~150ml (not including other parts of fracture fixed), average (51.82 + 43.09) ml, B group was 30~200ml, average (105.83 + 47.19) ml, A group was less than B group, the difference was statistically significant Fracture reduction quality: 4 cases of pelvic fracture in A group were satisfactory, 0 cases were dissatisfied, 3 cases were dissection in acetabular fracture, 4 cases were good reduction, 0 cases of.B group were satisfactory, 1 cases were dissatisfied, 5 cases of acetabular fracture, 2 cases of reduction, 1 cases of reduction and 1 cases, excellent 3 cases of A group. In 6 cases, there were 6 cases, 2 cases, 0 poor, 3 good in group B, 7 good, 1 and 1. No statistical significance was found in the fracture reduction quality of the two patients and the last follow-up of hip joint function (P0.05); in group A, 1 cases of the femoral lateral cutaneous nerve appeared in 1 cases, 1 cases appeared superficial infection of the mouth; and in group B patients after operation, 2 cases appeared thfemoral cutaneous nerve injury after operation. Symptoms, 1 cases of urinary tract infection, 2 cases of superficial wound infection, 1 cases of superficial femoral vein thrombosis, 1 cases of ectopic ossification. No postoperative fracture nonunion, acetabular infection and other complications, A group compared with group B, the postoperative complications were less, there was statistical significance (P0.05) conclusion: the application of MIPO technique for the pelvic and acetabular anterior column fracture creation of acetabular column treatment creation Less injury, less bleeding, shorter operation time, high safety and no exposure to femoral and femoral nerves.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

【引证文献】