微创治疗髋臼顶骨折的临床疗效

发布时间：2018-08-28 11:53

【摘要】：目的：本研究的目的在于就我院近年对髋臼顶骨折实施微创手术治疗的患者进行随访，探讨手术方法及其术后疗效，从而对髋臼顶区骨折的微创治疗提供相关理论依据方法：选择我院收治髋臼顶骨折患者26例，男16例，女10例，年龄23～79岁，平均52岁有并发症者12例，其中糖尿病4例，冠心病2例，高血压6例;按致伤原因:车祸伤19例，高空坠落5例，重物砸伤2例合并伤：内脏破裂３例，四肢骨折９例，颅脑外伤2例，后脱位2例数，胸部挫伤1例所有患者在情况稳定后，三周内（３～２１ｄ）手术所有脱位术前皆行闭合复位并行股骨髁上骨牵引以手术时间ǐ术中出血量ǐ住院时间ǐ卧床时间ǐ骨折复位情况ǐ术后功能恢复状态的情况作为手术的观察指标，以疼痛程度ǐ髋关节的功能ǐ畸形和髋关节活动为指标对手术效果进行评价结果：本组患者26例均顺利的完成手术，手术切口长10～15厘米，平均约12厘米，手术时间55～110分钟，平均约82分钟，术中失血量220～480毫升，平均约390毫升住院时间13～20天，平均约15天，卧床时间7～14天，平均约9天髋臼骨折的复位具体情况根据Matta标准［2］来评价:髋臼骨折的复位达到解剖复位的患者有21例(骨折断端的移位未超过1毫米)，复位达到满意复位的患者有5例(骨折的断端移位未超过3毫米)，只有一例患者的复位为不满意(骨折的断端移位超过了3毫米)根据D'Aubigne-Postel标准用来评价髋关节的功能:16例患者为优，5例患者达到良好，可的有4例，只有1例患者为差1例糖尿病患者在术后第3天伤口红肿，，经过控制血糖ǐ切口加强换药后控制无1例发生深静脉的血栓ǐ尿路的感染，无1例发生神经血管的损伤结论：微创治疗髋臼顶区骨折手术效果显著，具有手术出血量少ǐ创伤小ǐ异位骨化并发症少ǐ安全可靠ǐ且术后早期可行功能锻炼ǐ恢复好等优点，可以减轻病人所承受的痛苦，降低患者住院时间，而且更适合老年人髋臼骨折的手术治疗
[Abstract]:Objective: the purpose of this study was to follow up the patients with acetabular parietal fracture treated by minimally invasive operation in our hospital in recent years, and to explore the operative method and the effect after operation. So as to provide relevant theoretical basis for minimally invasive treatment of acetabular parietal fracture: 26 cases of acetabular parietal fracture were treated in our hospital, 16 males and 10 females, aged 23 to 79 years. There were 12 cases of complications in 52 years old, including 4 cases of diabetes mellitus, 2 cases of coronary heart disease, 6 cases of hypertension, according to the cause of injury: 19 cases of traffic accident injury, 5 cases of falling from high altitude, 2 cases of combined injury of heavy object injury: 3 cases of visceral rupture and 9 cases of limb fracture. There were 2 cases of craniocerebral trauma, 2 cases of posterior dislocation and 1 case of thoracic contusion. Within 3 weeks (3 ~ 21 days), all dislocation were treated with closed reduction before operation and supracondylar traction of the femur for the duration of operation, the amount of blood lost during operation, the time of stay in bed, the reduction of fracture and the recovery of function after operation. As an indication of the operation, The effect of the operation was evaluated by the functional deformity of hip joint and the hip joint activity. The results showed that 26 patients were successfully operated, the incision was 1015cm long. The average operation time was about 12 cm, the operation time was 55 ~ 110 minutes (mean 82 minutes), the blood loss during the operation was 220 ~ 480 ml, the average hospitalization time was about 390 ml for 1320 days, the average was about 15 days, and the bed rest time was 7 ~ 14 days. According to Matta criteria, 21 patients with acetabular fracture achieved anatomic reduction (the displacement of the broken end of the fracture was not more than 1 mm), and the reduction achieved satisfactory reduction. Five of the patients (the broken end displacement of the fracture was not more than 3 mm), and only one patient was dissatisfied with the reduction (the broken end displacement of the fracture exceeded 3 mm), and the function of hip joint was evaluated according to D'Aubigne-Postel criteria in 16 patients. 5 patients achieved good results, Of the 4 cases, only one case was poor. 1 case of diabetes mellitus suffered from wound redness and swelling on the 3rd day after operation. No infection of deep vein thrombus and urinary tract was controlled after enhanced dressing change through the incision of blood glucose control. Conclusion: minimally invasive treatment of acetabular parietal fracture was effective. It has the advantages of less operative bleeding, less trauma, less ectopic ossification complications, less safety and reliability, and better recovery of early feasible functional exercise after operation, which can alleviate the suffering of the patients and reduce the hospitalization time of the patients. It is also more suitable for the surgical treatment of acetabular fractures in the elderly.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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