两种入路方式治疗髋臼骨折合并骶髂关节骨折脱位的临床疗效比较  

Comparison of clinical curative effects between two approaches for treating acetabulum fracture complicating sacroiliac joint fracture dislocation

作　　者：温洋 陈丽媛 何克 刘东[1] 魏代清 阳波[1] WEN Yang;CHEN Liyuan;HE Ke;LIU Dong;WEI Daiqing;YANG Bo(First Department of Orthopedic Center,Suining Municipal Central Hospital,Suining,Sichuan 629000,China;Department of Bone and Joint Surgery,Affiliated Hospital of Southwest Medical University,Luzhou,Sichuan 646000,China)

机构地区：[1]四川省遂宁市中心医院骨科中心一病区,629000 [2]西南医科大学附属医院骨与关节外科,四川泸州646000

出　　处：《重庆医学》2019年第22期3801-3806,共6页Chongqing medicine

基　　金：四川省卫生和计划生育委员会科研课题(16pj549);西南医科大学校级资助基金计划(2014ZD-012);西南医科大学附属医院科研课题(15049)

摘　　要：目的比较腹直肌外侧入路与改良Stoppa直行入路髋臼骨折合并骶髂关节骨折脱位的临床疗效比较。方法选取遂宁市中心医院2013年2月至2016年3月27例髋臼骨折合并骶髂关节骨折脱位患者,分别采用腹直肌外侧入路与改良Stoppa直行入路治疗,将患者分为两组,其中腹直肌外侧(A组)15例,采用钢板固定骶髂关节;改良Stoppa直行入路(B组)12例,采用骶髂螺钉固定骶髂关节。将两种治疗方式在前方入路的手术显露时间、切口长度、术中出血量、总手术时间、骨折复位质量、术后髋关节功能评分进行比较。结果所有患者随访7~14个月,平均11.5个月。A组在前方入路切口长度、术中出血量、总手术时间方面优于B组,差异有统计学意义(P<0.01)。两组的前方入路显露时间、术后骨折复位质量(以Matta影像学评估标准评价)、术后髋关节功能评分(以改良Merle'Aubigne-Postel评分系统评分)差异无统计学意义(P>0.05)。结论腹直肌外侧入路与改良Stoppa直行入路均是髋臼骨折合并骶髂关节骨折脱位的理想切口,前者切口长度、术中出血量、总手术时间优于后者。Objective To compare the clinical curative effects between straight abdominal muscle lateral approach and modified Stoppa straight approach for treating acetabulum fracture complicating sacroiliac joint fracture dislocation.Methods Twenty-seven cases of acetabulum fracture complicating sacroiliac joint fracture dislocation in the Suining Municipal Central Hospital from February 2013 to March 27,2016 were selected and treated by adopting the straight abdominal muscle lateral approach and modified Stoppa straight approach.The cases were divided into the straight abdominal muscle lateral group(group A,n=15)treated by adopting the steel plate fixation of sacroiliac joint,and the modified Stoppa straight approach group(group B,n=12)treated by adopting sacroiliac screw to fix the sacroiliac join.Then the operative exposed time at the anterior approach,incision length,intraoperative blood loss volume,total operative time and fracture reduction quality,postoperative hip joint function score were compared between the two treatment methods.Results All cases were followed up for 7-14 months,with an average of 11.5 months.The incision length at the anterior approach,intraoperative blood loss volume and total operative time in the group A were superior to those in the group B,and the differences were statistically significant(P<0.01).The exposed time at the anterior approach,postoperative fracture reduction quality(evaluated by Matta imagiological evaluation standard),postoperative hip joint function score(modified Merle'Aubigne-Postel score system)had no statistical difference between the two groups(P>0.05).Conclusion Both straight abdominal muscle lateral approach and modified Stoppa straight approach are the ideal incision for treating acetabulum fracture complicating sacroiliac joint fracture dislocatio,but the former is better than the latter in the incision length,intraoperative blood loss volume and total operative time.

关 键 词：腹直肌外侧入路 改良Stoppa直行入路 骶髂螺钉 髋臼骨折 骶髂关节骨折脱位 

分 类 号：R683.3[医药卫生—骨科学]