摘要
目的比较改良髂腹股沟入路与Stoppa入路分别联合后外侧Kocher-Langenbeck(K-L)入路治疗复杂髋臼骨折的疗效。方法回顾分析2011年5月—2016年5月,应用前后联合入路治疗的62例复杂髋臼骨折患者临床资料。其中,采用改良髂腹股沟入路联合K-L入路34例(A组),Stoppa入路联合K-L入路28例(B组)。两组患者性别、年龄、致伤原因、骨折类型、受伤至手术时间、合并伤等一般资料比较,差异均无统计学意义(P>0.05)。记录两组手术时间、术中出血量及住院时间。X线片复查,参照Matta复位标准评价骨折复位情况,观察骨折愈合以及骨关节炎、异位骨化发生情况。根据改良d’Aubigne和Postel的髋臼骨折临床评分标准,评价患者髋关节功能恢复情况。结果两组手术时间、术中出血量及住院时间比较,差异均无统计学意义(P>0.05)。术后A、B组各2例K-L切口发生脂肪液化,A组1例发生下肢深静脉血栓形成;均无医源性损伤发生。术后56例患者获随访,A组30例随访时间为12～48个月,平均31.8个月;B组26例随访时间为12～46个月,平均30.2个月。术后12个月,根据改良d’Aubigne和Postel的髋臼骨折临床评分标准,A组获优9例、良16例、一般3例、差2例,优良率为83.3%;B组获优7例、良14例、一般2例、差3例,优良率为80.8%;两组比较差异无统计学意义(Z=0.353,P=0.724)。X线片复查示,A组骨折达解剖复位23例、满意复位6例、不满意复位1例,B组分别为20、5、1例,组间差异无统计学意义(Z=0.011,P=0.991)。两组骨折均达骨性愈合,骨折愈合时间比较差异无统计学意义(t=0.775,P=0.106)。随访期间A组出现明显骨关节炎改变5例、异位骨化2例、股骨头缺血性坏死2例,B组分别为4、2、1例,两组各并发症发生率比较差异均无统计学意义(P>0.05)。结论根据髋臼骨折部位和类型,合理选择改良髂腹股沟入路或Stoppa入路,再联合K-L入路治疗复杂性髋臼骨折,均可获满意疗效。
Objective To compare the effectiveness between modified ilioinguinal approach combined withKocher-Langenbeck (K-L) approach and Stoppa approach combined with K-L approach for the treatment of complicatedacetabular fractures. Methods Between May 2011 and May 2016, Sixty-two patients with complicated acetabularfractures were treated with operation via combined anterior and posterior approaches. Thirty-four cases (group A) weretreated with modified ilioinguinal approach combined with K-L approach, and 28 cases (group B) were treated withStoppa approach combined with K-L approach. There was no significant difference in gender, age, injury causes, the typeof fracture, time from injury to operation, and associated injury between 2 groups (P>0.05). The operation time,intraoperative blood loss, and hospitalization time were recorded. X-ray film was performed to evaluate the fracturereduction according to the Matta reduction criteria and observe the fracture healing, osteoarthritis, and heterotopicossification. Clinical results were evaluated according to the grading system of modified d'Aubigne and Postel.Results There was no significant difference in operation time, intraoperative blood loss, and hospitalization timebetween 2 groups (P>0.05). Postoperative incision fat liquefaction occurred in 2 cases in group A and group B respectively,and deep vein thrombosis of lower extremity occurred in 1 case in group A. No iatrogenic injury was found in 2 groups.Fifty-six patients were followed up after operation. Thirty patients in group A were followed up 12-48 months (mean, 31.8 months). Twenty-six patients in group B were followed up 12-46 months (mean, 30.2 months). At 12 months afteroperation, according to the grading system of modified d'Aubigne and Postel, the hip function was rated as excellent in9 cases, good in 16 cases, fair in 3 cases, and poor in 2 cases, with the excellent and good rate of 83.3% in group A; the hipfunction was rated as excellent in 7 cases, good in 14 cases, fair in 2 cases, and poor in 3 cases, with the excellent and goodrate of 80.8% in group B. There was no significant difference in the hip function between 2 groups (Z=0.353, P=0.724).The X-ray films showed that there were 23 cases of anatomical reduction, 6 cases of satisfactory reduction, and 1 case ofunsatisfactory reduction in group A, and 20 cases, 5 cases, and 1 case in group B, respectively. There was no significantdifference in the results of fracture reduction between 2 groups (Z=0.011, P=0.991). Fracture healing was observed in bothgroups. There was no significant difference in fracture healing time between 2 groups (t=0.775, P=0.106). During followup,5 cases of osteoarthritis changes, 2 cases of heterotopic ossification, and 2 cases of avascular necrosis of femoral headoccurred in group A, and 4 cases, 2 cases, and 1 case in group B, respectively. The difference between 2 groups was notsignificant (P>0.05). Conclusion According to the location and type of fracture, making a choice between the modifiedanterior approach and Stoppa approach, and then combined with K-L approach for treatment of complicated acetabularfracture, can obtain satisfactory effectiveness.
作者
姚运峰
薛晨曦
孙一松
詹俊峰
荆珏华
YAO Yunfeng;XUE Chenxi;SUN Yisong;ZHAN Junfeng;JING Juehua(Department of Orthopaedics,the Second Hospital of Anhui Medical University,Hefei Anhui,230603,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2018年第12期1512-1517,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
安徽省自然科学基金面上项目(1608085MH167)~~
作者简介
通信作者:荆珏华,Email:jingyhf2011@163.com
