3种不同手术入路比较治疗髋臼骨折的临床疗效  

Comparison of Three Different Surgical Approaches for the Treatment of Acetabular Fractures

作　　者：徐应龙[1] 戴海[1] 熊杰 徐耀锋 黄彩丽 黄宗贵[1] XU Ying-long;DAI Hai;XiONG Jie(Department of traumatology,the first people's hospital of Nanning,Nanning,Guangxi 530022)

机构地区：[1]南宁市第一人民医院创伤骨科,广西南宁530022

出　　处：《中国伤残医学》2021年第7期1-4,共4页Chinese Journal of Trauma and Disability Medicine

摘　　要：目的:从有效性及安全性比较3种不同手术入路治疗髋臼骨折的临床疗效.方法:回顾性搜集2015年1月-2020年1月在我院住院手术治疗的髋臼骨折患者病历资料,按手术入路分为改良Stoppa入路组,腹直肌旁入路组和髂腹股沟入路组,专人搜集各组病例的基线指标、临床观察指标及并发症,采用改良的Merle D'Aubigne and Postel评分系统随访评估术后6个月、12个月关节功能.结果:腹直肌旁入路组切口长度、手术时间小于改良Stoppa入路组,改良Stoppa入路组小于髂腹股沟入路组(P<0.05),3组入路手术患者术后骨折复位优良率、住院时间、骨折愈合时间、6个月及末次随访功能评分比较上差异无统计学意义(p>0.05).髂腹股沟入路组有1例术后伤口愈合不良.结论:髋臼前方3组入路均是治疗髋臼骨折的有效途径,腹直肌旁入路和改良Stoppa入路损伤更小,手术效率更高,尤其是腹直肌旁入路,更有助于后柱骨折的复位和螺钉置入.选择手术入路需综合考虑骨折形态、术者对于各手术入路的熟悉程度、各手术入路下骨折复位固定技巧等因素.Objective:To compare the effectiveness and safety of three different surgical approaches for the treatment of acetabular fractures.Methods:The medical records of patients with acetabular fracture hospitalized in our hospital from January 2015 to January 2020 were retrospectively collected.The patients were divided into modified Stoppa approach group,rectus abdominis approach group and iliac inguinal approach group according to the surgical approach.Baseline indicators、clinical observation indicators and complications were collected,the modified Merle D'Aubigne and Postel scoring system was used to assess the joint function at 6 and 12 months after operation.Results:The incision length and operation time of the rectus abdominis approach group were shorter than the modified Stoppa approach group,the modified Stoppa approach group was smaller than the iliac inguinal approach group(P<0.05).Hospitalization time,fracture healing time,6 months and the final follow-up function score were not significantly different(p>0.05).One patient in the iliac inguinal approach group had poor wound healing.Conclusion:The three groups of anterior acetabular approaches are effective ways to treat acetabular fractures.The injury of the rectus abdominis and the modified Stoppa approach are smaller and the surgical efficiency is higher,especially the para-abdominal approach,which is much more helpful for reduction and screw insertion of posterior column fractures.The selection of surgical approach requires comprehensive consideration of fracture morphology,the surgeon's familiarity with each surgical approach,and fracture reduction and fixation techniques under each surgical approach.

关 键 词：髋臼骨折 改良STOPPA入路 腹直肌旁入路 髂腹股沟入路 

分 类 号：R683.3[医药卫生—骨科学]