单一髂腹股沟入路与前后联合入路治疗髋臼双柱骨折的疗效比较  

Ilioinguinal approach versus combined anterior and posterior approach in treatment of double-column acetabular fractures

作　　者：顾善虎 陈加成 荣旺 殷照阳 孙晓 GU Shanhu;CHEN Jiacheng;RONG Wang;YIN Zhaoyang;SUN Xiao(Department of Emergency Surgery,the Affiliated Lianyungang Hospital of Xuzhou Medical University,the First People's Hospital of Lianyungang,Lianyungang,Jiangsu,222000,China)

机构地区：[1]徐州医科大学附属连云港医院(连云港市第一人民医院)急诊外科,江苏连云港222000

出　　处：《临床急诊杂志》2023年第6期287-291,共5页Journal of Clinical Emergency

基　　金：连云港市卫生健康委科研项目(No:ZD1901)。

摘　　要：目的:比较髂腹股沟入路与前后联合入路治疗髋臼双柱骨折的临床疗效。方法:选取我院2011年1月—2022年1月收治的髋臼双柱骨折患者65例,进行回顾性研究。65例均行手术治疗,根据手术入路不同,分为髂腹股沟入路组和前后联合入路组。其中髂腹股沟入路组32例,使用标准的髂腹股沟入路三窗显露复位骨折,前后联合入路组33例,前路使用髂腹股沟入路手术切口,后路使用Kocher-Langenbeck(K-L)入路。分析比较2组的患者的手术时间、出血量、术后并发症、复位质量以及髋关节功能评分。结果:所有患者获得7个月~5年(平均22个月)随访,髂腹股沟入路组和前后联合入路手术时间分别为(186±17) min、(215±24) min,出血量分别为(798±232) mL、(1 010±288) mL,前者明显优于后者(P<0.05)。髂腹股沟入路组和前后联合入路组术后1周Matta影像学评分优良率分别为87.5%(28/32)和90.9%(30/33),末次随访髋关节功能评分优良可率分别为90.6%(29/32)和87.8%(29/33),2组比较,差异无统计学意义(P>0.05)。并发症:髂腹股沟入路组术后切口浅表感染2例、深静脉血栓1例、股外侧皮神经麻痹3例;前后联合入路组术后切口浅表感染3例、深静脉血栓4例、股外侧皮神经麻痹2例。2组并发症发生率比较,差异有统计学意义(P<0.05)。结论:对于髋臼双柱骨折,髂腹股沟入路和前后联合入路都可以获得满意疗效,但髂腹股沟入路可缩短手术时间,术中失血量少,术后并发症少,在治疗髋臼双柱骨折中有一定的优势。Objective To compare the differences of clinical efficacy between ilioinguinal approach and combined anterior and posterior approach in the treatment of double-column acetabular fractures.Methods A retrospective study was conducted on 65 cases of double-column acetabular fractures admitted to our hospital from January 2011 to January 2022. According to the different surgical approaches, the 65 cases were divided into ilioinguinal approach group and combined anterior and posterior approach group. There were 32 cases in the ilioinguinal approach group, and 33 cases in the combined anterior and posterior approach group. The ilioinguinal approach incision was used anteriorly, and the Kocher-Langenbeck(K-L) approach was used posteriorly. The operation time, blood loss, postoperative fracture complications, reduction quality and hip function score were compared between the two groups.Results All patients were followed up for 7 months to 5 years(average, 22 months). The group of ilioinguinal approach was significantly superior to combined anterior and posterior approach group in operation time([186±17] min vs. [215±24] min) and blood loss([798±232] mL vs. [1 010±288]mL), with statistically significant differences(P < 0.05). There were no statistical differences in reduction of fractures(the excellent and good rate of 90.6%[29/32] vs. 87.8%[29/33], P>0.05) and hip function score(Matta standard, the excellent and good rate of 87.5%[28/32] vs. 90.9%[30/33], P>0.05) at final follow-up. Complications included 2 cases of superficial incision infection, 1 case of deep vein thrombosis and 3 cases of lateral femoral cutaneous nerve palsy in ilioinguinal approach group, and 3 cases of superficial incision infection, 4 cases of deep vein thrombosis, 2 cases of lateral femoral cutaneous nerve palsy in the combined anterior and posterior approach group. The incidence of complications between two groups had statistically significant difference(P < 0.05).Conclusion Both the ilioinguinal approach and the combined anterior and poste

关 键 词：髋臼 髂腹股沟入路 Kocher-Langenbeck入路 骨折 

分 类 号：R683.3[医药卫生—骨科学]