不同入路钢板固定治疗髋臼后部骨折的临床疗效比较  

Different approaches of plate fixation in the treatment of posterior acetabular fractures: Comparison of the therapeutic effects

作　　者：王腾 杨朝晖[1] 栗树伟[1] 李家琛 Wang Teng;Yang Zhaohui;Li Shuwei;Li Jiachen(Department of Orthopaedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《创伤外科杂志》2023年第3期184-189,203,共7页Journal of Traumatic Surgery

基　　金：山西省科技攻关项目(20200313015-13)。

摘　　要：目的对比Kocher-Langenbeck(K-L)、直接后方入路(direct posterior approach,DPA)用于髋臼后部骨折的临床疗效。方法回顾性分析山西医科大学第二医院骨科2020年2月—11月收治的93例髋臼后部骨折患者的临床资料,其中男性41例,女性52例;年龄18~74岁,平均54.0岁;骨折至手术时间1~4d,平均3.2d;高处坠落伤25例,道路交通伤44例,压砸伤19例,其他5例;骨折分型:后壁骨折28例,横行伴后壁骨折31例,后柱伴后壁骨折21例,T形骨折13例。根据入路方式不同将患者分为K-L组(K-L入路,n=43)和DPA组(DPA,n=50)。记录并对比两组临床围术期指标、髋关节功能恢复情况、创伤应激指标血清水平变化[皮质醇(cortisol,Cor)、去甲肾上腺素(norepinephrine,NE)、C反应蛋白(C-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor,TNF-α)]及并发症发生率。结果两组骨折愈合时间[K-L组:(8.6±0.3)周,DPA组:(8.5±0.3)周]比较差异无统计学意义(P>0.05)。DPA组的术中出血量少于K-L组[(358.64±40.38)mL vs.(462.23±68.52)mL],手术切口、手术时间短于K-L组[(10.28±2.51)cm vs.(15.53±3.76)cm、(72.7±9.8)min vs.(134.3±25.8)min,P<0.05]。DPA组术后1、3个月Harris评分高于K-L组[(63.5±7.3)分vs.(56.8±6.3)分、(76.3±6.7)分vs.(68.2±7.1)分,P<0.05];术后7d血清Cor、NE、CRP、TNF-α水平均低于K-L组[(398.96±51.65)ng/mL vs.(447.67±58.37)ng/mL、(7.23±1.08)nmol/L vs.(9.37±1.74)nmol/L、(19.24±5.57)mg/L vs.(28.48±5.45)mg/L、(6.98±1.87)ng/mL vs.(9.76±1.63)ng/mL,P<0.05]。两组并发症发生率(K-L组16.28%vs.DPA组6.00%)比较差异无统计学意义(P>0.05)。结论与K-L入路相比,DPA入路钢板固定治疗髋臼后部骨折更有利于减轻手术创伤,减少术中出血量,促进患者术后髋关节功能恢复。Objective To compare the therapeutic effects of Kocher-Langenbeck(K-L)and direct posterior approach(DPA)in the treatment of posterior acetabular fractures.Methods Clinical data of 93 patients with posterior acetabular fractures who were treated in our hospital from Feb.2020 to Nov.2020 were analyzed retrospectively.There were 41 males and 52 females aged 18-74 years,mean 54.0 years.The time from fracture to operation was 1-4 days,mean 3.2 days;causes of injuries were falls from height in 25 cases,road traffic injuries in 44,crush injuries in 19 and others in 5;and fracture types were posterior wall fractures in 28 cases,transverse plus posterior wall fractures in 31,combined posterior column and wall fractures in 21,and T-type fractures in 13.According to the surgical approaches,patients were divided into K-L group(K-L approach,n=43)and DPA group(DPA,n=50).The perioperative indexes,hip function recovery and serum levels of stress indexes following trauma,i.e.C-reactive protein(CRP),norepinephrine(NE),cortisol(Cor)and tumor necrosis factor-α(TNF-α),and the incidence of complications were recorded and compared between two groups.Results The fracture healing time(weeks)were similar between two groups(8.6±0.3 in K-L group vs.8.5±0.3 in DPA group),revealing no significant difference(P>0.05).Compared with K-L group,the DPA group showed significantly less intraoperative blood loss(mL,358.64±40.38 vs.462.23±68.52),smaller surgical incision(cm,10.28±2.51 vs.15.53±3.76),shorter operation time(min,72.7±9.8 vs.134.3±25.8),higher Harris hip function score at postoperative 1 month(63.5±7.3 vs.56.8±6.3)and 3 months(76.3±6.7 vs.68.2±7.1)and lower stress reaction at postoperative day 7:serum levels of Cor(ng/mL,398.96±51.65 vs.447.67±58.37),NE(nmol/L,7.23±1.08 vs.9.37±1.74),CRP(mg/L,19.24±5.57 vs.28.48±5.45)and TNF-α(ng/mL,6.98±1.87 vs.9.76±1.63),all P<0.05.As for the incidence of complications,no significant difference was showed between K-L group(16.28%)and DPA group(6.00%),P>0.05.Conclusion Compared with

关 键 词：髋臼后部骨折 入路 钢板固定 疗效 

分 类 号：R683.3[医药卫生—骨科学]