腹主、髂总动脉阻断与髂内动脉结扎控制出血在复杂性髋臼骨折手术中的比较  

Comparison of temporary occlusion of abdominal aorta, temporary occlusion of common iliac artery and internal iliac artery ligation in the treatment of complex acetabular fracture

作　　者：胡争波 邵勇军 赵忠清 袁艾东 张恒 钟志年 何正言 李文虎 Hu Zhengbo;Shao Yongjun;Zhao Zhongqing;Yuan Aidong;Zhang Heng;Zhong Zhinian;He Zhengyan;Li Wenhu(Department of Orthopaedic Trauma,Shaoguang Hospital Affiliated to Southern Medical University,Shaoguang 512000,China)

机构地区：[1]南方医科大学附属韶关医院、广东省韶关市第一人民医院创伤骨科,512000

出　　处：《中华创伤骨科杂志》2019年第2期144-152,共9页Chinese Journal of Orthopaedic Trauma

摘　　要：目的比较腹主动脉介入球囊临时阻断术(TOAAIB)、髂总动脉介入球囊临时阻断术(TOCAIIB)与术中髂内动脉结扎术(IIAL)术中控制复杂髋臼骨折骨盆大出血的临床应用价值。方法回顾性分析2000年1月至2017年1月广东省韶关市第一人民医院创伤骨科收治的113例复杂性髋臼骨折患者资料。男68例,女45例;年龄为23~61岁,平均42.3岁;骨折按Letournel分型均属于复合骨折,其中T型骨折10例,双柱骨折24例,后柱+后壁骨折16例,横型+后壁骨折46例,前方+后半横型骨折15例。均采用切开复位内固定手术治疗。根据术中采用控制出血的方法不同分为3组:37例患者应用TOAAIB治疗,31例采用TOCAIIB治疗,45例采用IIAL治疗。术后采用Matta标准评定骨折复位质量;记录各病例术中出血量、术后伤口引流量、术后骨折及介入相关并发症发生率;并在骨折愈合后采用Modifiedd′Aubigne&Postal临床分级系统评价髋关节功能。结果TOAAIB组、TOCAIIB组和IIAL组患者的性别、年龄、受伤至手术时间、骨折Letournel分型、手术入路等资料比较差异均无统计学意义(P>0.05),具有可比性。术中解剖复位91.15%(103/113)。TOAAIB、TOCAIIB和IIAL组术中出血量分别为(1631.5±675.5)、(892.6±217.7)和(648.0±170.2)mL,差异有统计学意义(P<0.05)。TOAAIB组在手术结束时有1例出现股动脉血栓,取出后经抗凝对症处理痊愈;TOCAIIB和IIAL组患者术后未见介入相关并发症发生。三组在术后引流量、骨折愈合时间、Modifiedd′Aubigne&Postal髋关节功能评分、术后并发症发生率等方面差异均无统计学意义(P>0.05)。结论TOAAIB在复杂髋臼骨折中控制出血效果最佳,TOCAIIB效果次之,术中IIAL效果最差;但临床上依术者及患者具体情况选择应用为宜。Objective To compare the effectiveness of controlling blood loss in the treatment of complex acetabular fracture between temporary occlusion of abdominal aorta by interventional balloon (TOAAIB),temporary occlusion of common iliac artery by interventional balloon (TOCAIIB) and internal iliac artery ligation (IIAL). Methods Included for this study were 113 complex acetabular fractures which had been treated at Department of Orthopaedic Trauma,Shaoguang Hospital Affiliated to Southern Medical University from January 2000 through January 2017.There were 68 males and 45 females,aged from 23 to 61 years (average,42.3 years).According to the Letournel classification,all of them belonged to complex fractures,including 10 T-type,24 double-column,16 posterior column & posterior wall,46 trans-verse & posterior wall and 15 anterior & posterior half-transverse ones.They were all treated by open reduction and internal fixation but differed in surgical hemostasis techniques: TOAAIB was used in 37 cases,TOCAIIB in 31 and IIAL in 45.Fracture reduction was evaluated by Matta criteria.Intraoperative bleeding and postoperative wound drainage,fracture union and complications related to interventions were recorded.Hip function was evaluated by Modified d'Aubigne & Postal clinical grading system after fracture healing. Results The 3 groups (TOAAIB,TOCAIIB and IIAL) were comparable because there were no significant differences in gender,age,time from injury to surgery,Letournel classification or surgical approaches between the patients in the 3 groups (P>0.05).Anatomical reduction was achieved in 91.15% of the patients (103/113) and satisfactory reduction in 8.85% (10/113).Intraoperative hemorrhage was 1,631.5±675.5 mL in the IIAL group,892.6±217.7 mL in the TOCAIIB group and 648.0±170.2 mL in the TOAAIB group,showing significant differences between the 3 groups (P<0.05).One case of femoral artery thrombosis occurred in the TOAAIB group at the end of operation but was cured by symptomatic treatment of anticoagulation.There were no i

关 键 词：腹主动脉 髂总动脉 髂内动脉 阻断 复杂性髋臼骨折 

分 类 号：R687.3[医药卫生—骨科学]