特定复位顺序在治疗合并髋臼骨折的Tile C型骨盆骨折中的作用  

The effect of a specific reduction sequence in the treatment of Tile C pelvis fracture with acetabular fracture

作　　者：李琳[1] 王琦[1] 于震 孙洋洋 吕尧 谭国庆[3] 傅佰圣 李庆虎 周东生[1,2] Li Lin;Wang Qi;Yu Zhen;Sun Yangyang;Lyv Yao;Tan Guoqing;Fu Baisheng;Li Qinghu;Zhou Dongsheng(Department of Traumatology and Orthopedics,Shandong Provincial Hospital,Cheeloo College of Medicine,Shandong University,Jinan 250021,China;Department of Traumatology and Orthopedics,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China;Department of Spinal Surgery,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250011,China)

机构地区：[1]山东大学附属省立医院创伤骨科,济南250021 [2]山东第一医科大学附属省立医院创伤骨科,济南250021 [3]山东中医药大学附属医院脊柱外科,济南250011

出　　处：《中华骨科杂志》2021年第18期1324-1332,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81672156);山东省重点研发计划(2015GSF118098);山东省重点研发计划(2017GSF18112);。

摘　　要：目的通过按特定顺序复位手术治疗合并髋臼骨折的Tile C型骨盆骨折,并探讨其临床疗效。方法回顾性分析2014年1月至2019年6月收治的53例Tile C型骨盆骨折合并髋臼骨折患者临床资料,根据术中骨折复位的顺序分为特定顺序组和非特定顺序组。特定顺序组29例,其中男20例,女9例;年龄(43.8±14.8)岁(范围18~71岁),术中均采用"先内后外,先上后下"顺序进行骨折复位;非特定顺序组24例,其中男14例,女10例;年龄(44.4±14.7)岁(范围18~69岁),未按照该顺序复位。根据骨盆和髋臼骨折损伤类型,选择合适的体位和手术入路,切开复位骨折后,采用内植物固定。比较两组的术中出血量、手术时间、疼痛视觉模拟评分,骨折复位质量采用Matta评分,骨盆骨折功能恢复采用Majeed评分,髋臼骨折采用髋关节改良Merle d’Aubigné-Postel评分进行评定。结果特定顺序组和非特定顺序组患者术前一般资料比较的差异均无统计学意义,具有可比性。特定顺序组和非特定顺序组术中出血量分别为(1031.1±513.7)、(1406.3±738.1)ml,手术时间分别为(3.5±1.0)、(4.8±1.4)h,差异均有统计学意义(均P<0.05)。53例随访时间(14.8±1.6)个月(范围12~18个月)。特定顺序组和非特定顺序组术后VAS评分为(1.3±1.1)、(1.5±1.3)分,差异无统计学意义(P>0.05)。骨盆骨折Matta评分:特定顺序组优22例,良5例,可2例,优良率93.1%;非特定顺序组优10例,良6例,可5例,差3例,优良率66.7%,差异有统计学意义(P<0.05)。髋臼骨折Matta评分:特定顺序组优21例,良5例,差3例,优良率89.7%;非特定顺序组优9例,良8例,差7例,优良率70.8%,差异有统计学意义(P<0.05)。末次随访骨盆骨折Majeed评分:特定顺序组优20例,良7例,可2例,优良率93.1%;非特定顺序组优10例,良5例,可5例,差4例,优良率62.5%,差异有统计学意义(P<0.05)。末次随访时髋关节改良Merle d’Aubigné-Postel评分:特定顺序组优20例,良5例,可4例Objective To explore the clinical effect of open reduction in the treatment of Tile C pelvic fracture combined with acetabular fracture in a specific sequence.Methods Retrospectively analyzed the clinical data of 53 patients with Tile C type pelvic fracture combined with acetabular fracture from January 2014 to January 2019,and were divided into specific sequence group and non-specific sequence group according to the sequence of intraoperative reduction.A total of 29 cases were observed in the specific sequence group,including 20 males and 9 females;aged 43.8±14.8 years old(18-71 years),and the fractures were reduced in the sequence of"inside and out,then up and down"during the operation.There were 24 cases in the non-specific sequence group,including 14 males and 10 females;aged 44.4±14.7 years old(18-69 years),and fracture reduction was not performed in this sequence during the operation.According to the type of pelvic and acetabular fracture injury,we choose the appropriate position and surgical approach.After open reduction,the fracture was fixed with internal plants.The intraoperative blood loss,operation time,visual analogue scale(VAS)score were compared between the two groups.The quality of fracture reduction was evaluated by Matta score,pelvic fracture function recovery was evaluated by Majeed score,and acetabular fracture was evaluated by hip joint modified Merle d'Aubigné-Postel score.Results There was no statistically significant difference in general data between the two groups before operation(P>0.05),which was comparable.The intraoperative blood loss of the specific sequence group and the non-specific sequence group were 1031.1±513.7 and 1406.3±738.1 ml,and the operation time was 3.5±1.0 and 4.8±1.4 h;The differences between the two groups were statistically significant(P<0.05).53 patients were followed up for 14.8±1.6 months(12-18 months)after operation.The average postoperative VAS scores of specific sequence group and non-specific sequence group were 1.3±1.1 and 1.5±1.3 respectively,and

关 键 词：骨盆 髋臼 骨折 骨折切开复位 对比研究 

分 类 号：R687.3[医药卫生—骨科学]