前后路手术治疗骶髂关节新月型骨折疗效比较  

Operative Treatment of Crescent Fracture:Comparison of the Outcomes by Anterior or Posterior Approach

作　　者：秦晖[1] 安智全[1] 姜朝来[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《实用骨科杂志》2011年第12期1073-1076,共4页Journal of Practical Orthopaedics

摘　　要：目的比较经前侧和后侧入路手术治疗新月型骨折的疗效。方法回顾分析2007年4月至2010年1月收治的30例新月型骨折患者临床资料,其中采用前路手术治疗18例（A组）,后路手术治疗12例（B组）。A组：男11例,女7例;年龄19~52岁,平均32岁。术前骨盆后环骨折的移位程度5~24 mm,平均（13.7±5.8）mm。受伤至行骨盆手术时间3~22 d,平均7.8 d。B组：男8例,女4例;年龄21~55岁,平均31岁。术前骨盆后环骨折的移位程度8~23mm,平均（12.4±4.7）mm。受伤至行骨盆手术时间3~9 d,平均6.2 d。两组患者一般资料比较,差异均无统计学意义（P〉0.05）,具有可比性。结果 A、B组失血量分别为（661.1±203.3）mL和（412.5±128.1）mL,比较差异有统计学意义（P〈0.05）;A、B组手术时间分别为（175±31.3）min和（172.5±34.1）min;术后骨盆后环骨折移位分别为（1.2±0.9）mm和（0.8±0.9）mm,手术纠正移位分别为（12.6±5.9）mm和（11.7±4.6）mm,比较差异均无统计学意义（P〉0.05）。术后均未出现腰骶神经的损伤。A组15例获平均16.1（13~22）个月随访,B组10例获得平均16.3（12~20）个月随访。X线片示两组骨折均愈合,A组愈合时间为（3.6±0.5）个月,B组为（3.1±0.3）个月,差异有统计学意义（P〈0.05）。根据Hannover评分标准,临床症状恢复A组优10例（66.7%）,良5例（33.3%）;B组优7例（70%）,良3例（30%）。两组优良率比较差异无统计学意义（P〉0.05）。重返社会能力：A组完全重返13例（86.7%）,部分重返2例（13.3%）;B组完全重返8例（80%）,部分重返2例（20%）,差异无统计学意义（P〉0.05）。结论前方入路手术和后方入路手术治疗新月型骨折均可以取得良好的效果,但是后路手术出血量少、骨折愈合时间快是更好的治疗选择。Objective To compare the effectiveness of two different operative approachs：anterior approach and posterior approach in treatment of the crescent fracture.Methods The clinical data were retrospectively analyzed and compared from 30 cases with crescent fractures between April 2007 and January 2010.All the patients were divided into 2 groups;18 patients were treated via anterior approach（group A） and 12 patients were treated via posterior approach（group B）.In group A,there were 11 males and 7 females with average age of 32 years（range 19～52）.The average displacements of posterior pelvic ring fractures before surgery were（13.7±5.8） mm（range 5～24 mm）.The time from injury to operation was 3 to 22 days with an average of 7.8 days.In group B,there were 8 males and 4 females with average age of 31 years（range 21～55）.The displacement of posterior pelvic ring fractures before surgery were（12.4±4.7） mm（range 8～23 mm）.The time from injury to operation was 3 to 9 days with an average of 6.2 days.There was no signi cant differences in general data between 2 groups（P0.05）.Results The blood loss was（661.1±203.3） mL in group A and（412.5±128.1） mL in group B,showing signi？cant differences（P0.05）.The operation time,the displacement of posterior pelvic ring fractures after surgery and the reduction gained of posterior pelvic ring fractures was（175±31.3） minutes,（1.2±0.9） mm,（12.6±5.9） mm in group A and（172.5±34.1） minutes,（0.8±0.9） mm,（11.7±4.6） mm in group B respectively,showing no signi？cant differences（P0.05）.There were no neurologic complications associated with the pelvic surgery in 2 groups.15 patients were followed up 16.1 months on average（range 13～22 months） in group A and 16.3 months on average（range 12～20 months） in group B.The X-ray films showed bony healing in all patients.The fracture union time was（3.6±0.5） months in group A and（3.1±0.3） months in group B,showing signi cant differences（P0.05）.T

关 键 词：新月型骨 骶髂关节 骨折脱位 

分 类 号：R683.3[医药卫生—骨科学]