改良Stoppa入路联合髂窝入路治疗C型骨盆骨折疗效分析

发布时间：2018-05-05 09:27

本文选题：改良Stoppa入路联合髂窝入路 + C型骨盆骨折　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过对改良Stoppa入路联合髂窝入路治疗骨盆C型骨折的患者的预后随访跟踪调查总结,来判断临床治疗效果,总结经验,讨论进一步提高治疗效果,以便推广到临床上得到更广泛的使用等。资料与方法:自2014年9月至2016年7月期间对选取吉林大学中日联谊医院的17例通过改良Stoppa入路联合髂窝入路治疗骨盆C型骨折患者例进行随访回顾性研究分析,其中男12例,女5例,年龄11-70岁,平均42.88岁,术后随访6-22个月,平均随访12个月。骨折复位情况采用Matta标准进行评价,术后末次随访功能恢复情况采用Majeed功能评价系统。记录患者手术时间、术中出血量、术中输血量、骨性愈合时间、坐骨神经损伤、感染等并发症等。结果:采用改良Stoppa入路联合髂窝入路治疗骨盆C型骨折的患者17例,术后随访6-22个月,术中出血量450-1400ml,平均出血量750ml,术中输血量2-8U,平均输血量4.2U,手术时间120-500min,平均手术时间210min,骨盆骨折均骨性愈合,骨折愈合2-6个月,平均3.5个月。术后并发症发生2例,均为下肢深静脉血栓。骨盆骨折术后复位情况:优12例,良4例,一般1例,差0例,优良率:94.1%。末次随访Majeed功能评分系统:优10例,良4例,可1例,差2例。优良率:82.4%。结论:改良Stoppa入路联合髂窝入路治疗骨盆C型骨折的患者进行了完整的随访,平均随访12个月,Matta评定分析:优12例,良4例,一般1例,差0例,优良率94.1%。末次随访Majeed功能评分系统:优10例,良4例,可1例,差2例。优良率:82.4%。患者手术平均时间210min,术中出血量平均750ml,术中输血量平均4.2U,骨盆骨折均骨性愈合,骨折愈合2-6个月,平均3.5个月。术后并发症发生2例,均为下肢深静脉血栓。患者均无感染,除一例因外伤致坐骨神经离断外,其余均无重要神经血管损伤。改良Stoppa入路联合髂窝入路治疗C型骨盆骨折,手术视野显露充分,手术操作相对简便,降低手术难度,骨盆骨折复位率高,可以很好解决合并髂骨骨折和骶髂关节脱位等问题,骨折复位程度满意及下肢功能恢复良好,远期髋关节功能较好,并发症少。
[Abstract]:Objective: to investigate the prognosis of patients with pelvic type C fracture treated by modified Stoppa approach combined with iliac fossa approach, to judge the clinical treatment effect, to sum up the experience, and to discuss how to improve the therapeutic effect. In order to be extended to the clinical use of more extensive, and so on. Materials and methods: from September 2014 to July 2016, 17 patients with pelvic type C fracture treated by modified Stoppa approach and iliac fossa approach were retrospectively analyzed, including 12 males. The average age of female was 42.88 years old (11-70 years old). The postoperative follow-up was 6 to 22 months, with an average follow-up of 12 months. Matta criteria were used to evaluate the reduction of fracture, and Majeed system was used to evaluate the functional recovery after the last follow-up. The operative time, blood loss, blood transfusion, bone healing time, sciatic nerve injury, infection and other complications were recorded. Results: 17 cases of pelvic type C fracture were treated by modified Stoppa approach combined with iliac fossa approach. The intraoperative blood loss was 450-1400ml, the average bleeding was 750ml, the intraoperative blood transfusion was 2-8U, the average blood transfusion was 4.2U, the operative time was 120-500 mins, the average operative time was 210min. The pelvic fractures healed for 2-6 months (mean 3.5 months). Postoperative complications occurred in 2 cases, all of which were deep venous thrombosis of lower extremity. The postoperative reduction of pelvic fractures was excellent in 12 cases, good in 4 cases, fair in 1 case, poor in 0 cases. The last follow-up Majeed function scoring system was excellent in 10 cases, good in 4 cases, fair in 1 case and poor in 2 cases. The excellent rate is 82.4%. Conclusion: the patients with type C pelvic fracture treated by modified Stoppa approach combined with iliac fossa approach were followed up for 12 months on average. The results showed that 12 cases were excellent, 4 cases were good, 1 case was fair, 0 case was poor, and the excellent and good rate was 94.1%. The last follow-up Majeed function scoring system was excellent in 10 cases, good in 4 cases, fair in 1 case and poor in 2 cases. The excellent rate is 82.4%. The mean operative time was 210 min, the average blood loss was 750 ml, the average blood transfusion was 4.2 U, and the pelvic fractures were healed for 2 to 6 months (mean 3.5 months). Postoperative complications occurred in 2 cases, all of which were deep venous thrombosis of lower extremity. No infection was found in all patients, except for one case of sciatic nerve dissection due to trauma. The modified Stoppa approach combined with iliac fossa approach for the treatment of type C pelvic fractures has the advantages of full exposure of surgical visual field, relatively simple operation, low difficulty of operation, high reduction rate of pelvic fractures, and can solve the problems of complicated iliac fractures and sacroiliac joint dislocation. The degree of fracture reduction was satisfactory and the lower limb function recovered well, long-term hip joint function was better and complications were less.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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