MIPPO技术在不稳定骨盆前环骨折治疗中的临床疗效分析

发布时间：2018-05-18 14:28

本文选题：骨盆骨折前环 + MIPPO技术　；参考：《皖南医学院》2015年硕士论文

【摘要】：目的:探讨MIPPO技术在不稳定型骨盆前环骨折治疗中的临床疗效。方法:选择2010年9月至2014年09月,收集的29例病例,由同一术者实施不稳定型骨盆骨折前环的手术治疗,其中男15例,女14例;年龄32-65岁,平均年龄47.41?8.3岁。损伤原因:高空坠落15例,车祸12例,重物砸伤2例;29例患者按Tile分类方式,B1型5例,B2型7例,B3型6例,C1型5例,C2型3例,C3型3例;合并高血压7例,糖尿病4例,冠心病2例,脑外伤、胸腔积液、全身多发骨折18例;合并膀胱破裂1例。患者伤后至手术时间4-8天,平均6.21天。所有患者采用回顾性分析,根据手术方式分组,MIPPO组和传统髂腹股沟入路组,收集患者的伤后至手术间隔时间、术中持续时间、术中出血量、术后引流量、骨折负重时间等数据比较,患者出院后1、3、6、12、24月复查骨盆X线片了解骨折愈合情况,骨折复位情况Matta评分和术后恢复情况Majeed评分。结果:29例患者均获随访。MIPPO组:手术持续时间(76.69?21.21min),术中出血量(140.63?17.15ml),术后引流量(66.16?9.45ml),切口长度(7.13?1.09cm),骨折愈合时间(7.94?1.12w),完全负重时间(10.31?1.30w);传统组:手术持续时间(102.30?23.23min),术中出血量(171.77?28.46ml),术后引流量(113.77?15.18ml),切口长度(10.19?1.18cm),骨折愈合时间(9.31?1.49w),完全负重时间(11.46?1.56w)。两组在手术持续时间、术中出血量、术后引流量、骨折愈合时间及完全负重时间方面比较,P0.05,差异有统计学意义。根据Matta评价标准,MIPPO组优8例,良4例,中3例,差1例,优良率为75%;传统组优8例,良4例,中1例,差0例优良率为92.31%。按Majeed评分标准总分100分,MIPPO组优7例,良7例,中2例,差0例,优良率为87.5%;传统组优6例,良5例,中1例,差1例,优良率为84.6%。结论:总的来说,MIPPO组较传统组具有切口小、操作简单、出血较少、手术时间短等特点,在骨盆前环骨折复位、固定及术后恢复方面具有相似的疗效,掌握一定的手术时机及技巧在不稳定骨盆骨折前环治疗中MIPPO微创钢板可以替换传统的切开复位方法。
[Abstract]:Objective: to evaluate the clinical effect of MIPPO technique in the treatment of unstable anterior pelvic ring fractures. Methods: from September 2010 to September 2014, 29 cases of unstable pelvic fractures were operated on by the same operation, including 15 males and 14 females, aged 32-65 years with an average age of 47.41 years (8.3 years). The causes of injury were as follows: falling from high altitude in 15 cases, traffic accident in 12 cases, and heavy object injury in 2 cases (29 cases). According to Tile classification, there were 5 cases of B _ 1 type B _ 2 type B _ 3 and 6 cases of C _ 1 type C _ 2 type C _ 3, 3 cases of C _ 3 type C _ 3, 7 cases of hypertension, 4 cases of diabetes mellitus, 3 cases of C _ 3 type, 7 cases of hypertension and 4 cases of diabetes mellitus. There were 2 cases of coronary heart disease, 2 cases of brain injury, 18 cases of pleural effusion, 18 cases of systemic multiple fracture, and 1 case of bladder rupture. The time from injury to operation was 4-8 days, with an average of 6. 21 days. All the patients were divided into MIPPO group and traditional ilioinguinal approach group according to the operation method. The time between injury and operation, the duration of operation, the amount of blood lost during operation and the drainage flow after operation were collected. The data of weight bearing time of fracture were compared. The pelvic radiographs were reexamined at 12 and 24 months after discharge to find out the fracture healing, the Matta score of fracture reduction and the Majeed score of postoperative recovery. Results all 29 cases were followed up. MIPPO group: operation duration was 76.69 卤21.21 min, intraoperative bleeding volume was 140.63 卤17.15 ml, postoperative drainage volume was 66.16 卤9.45 ml, incision length was 7.131.09 cm, fracture healing time was 7.941.12 ws, full weight loading time was 10.31 and 1.30 ws; traditional group: operation duration was 102.300.23 min, intraoperative blood loss was 171.77 ~ 28.46 ml, postoperative time of fracture healing was 10.31 min and 1.30 ws; traditional group: operation duration was 102.3023 min, intraoperative blood loss was 171.77 ~ 28.46 ml / min, postoperative time was 1.30 min. The drainage volume was 113.77 ~ 15.18 ml / L, the incision length was 10.19 ~ 1.18 cm ~ (-1), the fracture healing time was 9.31 ~ 1.49 weeks, and the total load time was 11.46 ~ 1.56 wN. There were significant differences between the two groups in operation duration, intraoperative blood loss, postoperative drainage, fracture healing time and total weight bearing time (P 0.05). According to Matta evaluation criteria, the excellent rate was 8 cases, good 4 cases, fair 3 cases, poor 1 case, excellent and good rate 75%, excellent 8 cases, good 4 cases, medium 1 case and poor 0 cases 92.31% in traditional group. According to the total score of Majeed, 7 cases were excellent, 7 cases were good, 2 cases were medium, 0 cases were poor, the excellent and good rate was 87.5%, while in the traditional group, 6 cases were excellent, 5 cases were good, 1 case was medium, 1 case was poor, and the excellent and good rate was 84.6%. Conclusion: in general, the MIPPO group has smaller incision, simpler operation, less bleeding and shorter operation time than the traditional group. It has similar curative effect in the reduction, fixation and postoperative recovery of pelvic anterior ring fracture. MIPPO minimally invasive plate can replace the traditional open reduction method in the treatment of unstable pelvic fractures with MIPPO minimally invasive plate.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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