改良Stoppa入路结合髂窝入路治疗复杂四边体骨折的临床疗效

发布时间：2019-07-04 08:14

【摘要】：目的:回顾性分析改良Stoppa入路结合髂窝入路治疗的复杂四边体骨折的临床疗效,为多样化的临床治疗方案选择提供有力参考。方法:回顾性分析我院骨科2012年9月-2016年9月间,经同一组手术人员完成治疗的复杂髋臼四边体骨折患者资料43例,且完成随访,将所纳入患者分为A、B两组,A组患者采用改良Stoppa入路结合髂窝入路治疗,B组患者采用髂腹股沟入路治疗。A组患者中男15例,女9例,年龄51±4.7岁,根据Letournel-Judet髋臼骨折分型:双柱骨折18例,前柱伴后半横行4例,T形骨折1例,横行骨折1例;B组中男12例,女7例,年龄49±5.2岁,Letournel-Judet髋臼骨折分型双柱骨折13例,前柱伴后半横行3例,T形骨折1例,横行骨折2例。对比术前、术后患者的影像学资料,采用Matta标准来评价骨折复位质量,同时记录手术时间、术中出血量、术后并发症以及末次随访患肢功能评分等,患肢功能评分采用改良的Merle d’Abubigne和Postel评分系统评定。两组患者的一般资料对比差异无统计学意义(P0.05),具有可比性。结果:两组患者均顺利完成手术并获得术后随访。A、B两组患者手术时间分别为95±25分钟、110±15分钟,术中失血量分别为425±121.5毫升、725±175毫升,两观察指标间存在统计学意义(P0.05)。Matta骨折复位评价结果显示:A组达到解剖复位(优)的患者15例,达到满意复位(良)的患者6例,复位为不满意(差)的患者3例,优良率达87.5%;B组达到解剖复位(优)的患者12例,达到满意复位(良)的患者4例,复位尚可(可)的患者2例,复位为不满意(差)的患者1例,优良率达84.2%,两组患者间Matta骨折复位质量无统计学差异(P0.05)。Merle d’Abubigne和Postel评分系统评定示:A组优17例,良3例,一般1例,差3例,优良率83.3%;B组优11例,良4例,一般2例,差2例,优良率78.9%,两组患者髋关节功能评分无统计学差异(P0.05)。两组患者并发症发生率比较无统计学差异(P0.05)。结论:改良Stoppa入路结合髂窝入路在充分暴露四边体骨折区及真骨盆缘区域具有明显优势,可直视下复位并固定四边体骨折,是治疗复杂四边体骨折的良好手术入路。改良Stoppa入路结合髂窝入路手术时间较短,损伤相对较小,术中出血量相对较低,完成骨折固定复位后可较早行术后功能锻炼。对于老年患者发生复杂髋臼四边体骨折情况,本身手术难度较大,应用该入路可在一定程度上降低手术难度,缩短患者术后恢复时间。而对于合并其他特殊类型复杂髋臼骨折可选择同时联合其他入路,如Kocher-Langenbeck入路辅助进行治疗,临床上也可取得较为满意的结果。
[Abstract]:Objective: to analyze the clinical effect of modified Stoppa approach combined with iliofossa approach in the treatment of complex tetrahedral fractures, and to provide a powerful reference for the choice of various clinical treatment schemes. Methods: from September 2012 to September 2016, 43 patients with complex acetabular quadrangle fractures were treated by the same group of surgical personnel and were followed up. The patients in group A were divided into two groups: group A was treated with modified Stoppa approach combined with iliofossa approach, and group B was treated with ilioinguinal approach. In group A, there were 15 males and 9 females, aged 51 卤4.7 years. According to Letournel-Judet acetabular fracture classification, there were 18 cases of double column fracture, 4 cases of anterior column with posterior half transverse fracture, 1 case of T shaped fracture and 1 case of transverse fracture. In group B, there were 12 males and 7 females, aged 49 卤5.2 years. 13 cases of Letournel-Judet acetabular fracture were classified as double column fracture, 3 cases of anterior column with posterior half transverse fracture, 1 case of T-shaped fracture and 2 cases of transverse fracture. Compared with the imaging data of the patients before and after operation, the quality of fracture reduction was evaluated by Matta standard, and the operation time, intraoperative bleeding volume, postoperative complications and the functional score of the affected limbs were recorded at the same time. The functional scores of the affected limbs were evaluated by the improved Merle d'Abubigne and Postel scoring system. There was no significant difference in general data between the two groups (P 0.05), which was comparable. Results: the operation time of group A and group B was 95 卤25 minutes and 110 卤15 minutes, respectively, and the blood loss during operation was 425 卤121.5 ml and 725 卤175ml, respectively. there was statistical significance between the two indexes (P 0.05). The results of reduction evaluation of Matta fracture showed that 15 patients in group A achieved anatomical reduction (excellent) and 6 patients achieved satisfactory reduction (good). There were 3 patients with unsatisfactory (poor) reduction, the excellent and good rate was 87.5%. In group B, there were 12 patients with anatomical reduction (excellent), 4 patients with satisfactory reduction (good), 2 patients with satisfactory reduction (fair) and 1 patient with unsatisfactory (poor) reduction, the excellent and good rate was 84.2%. There was no significant difference in the reduction quality of Matta fracture between the two groups (P 0.05). Merle d'Abubigne and Postel scoring system evaluation showed that 17 patients in group A were excellent, 3 good, 1 general and 3 poor. The excellent and good rate was 83. 3%. In group B, 11 cases were excellent, 4 cases were good, 2 cases were general, 2 cases were poor, the excellent and good rate was 78.9%. There was no significant difference in hip function score between the two groups (P 0.05). There was no significant difference in the incidence of complications between the two groups (P 0.05). Conclusion: modified Stoppa approach combined with iliofossa approach has obvious advantages in fully exposed quadrangular fracture area and true pelvic margin area. It can be reduced and fixed under direct vision. It is a good surgical approach for the treatment of complex quadrangular fracture. The modified Stoppa approach combined with the ilium fossa approach has the advantages of short operation time, relatively small injury and relatively low amount of intraoperative bleeding. After the fracture fixation and reduction is completed, the postoperative functional exercise can be performed earlier. For the elderly patients with complex acetabular tetrahedral fracture, it is difficult to operate. The application of this approach can reduce the difficulty of operation to a certain extent and shorten the postoperative recovery time of the patients. For other special types of complex acetabular fractures, we can choose to combine with other approaches, such as Kocher-Langenbeck approach to assist in the treatment, and can also achieve satisfactory results in clinic.
【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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