本文選題：髖臼骨折 + 改良Stoppa入路��； 參考：《福建中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:比較髖臼骨折手術(shù)治療中改良Stoppa入路與髂腹股溝入路的臨床療效。方法:回顧性分析2011年1月至2016年8月期間,在福建省立醫(yī)院采用前方手術(shù)入路治療的髖臼骨折臨床資料,共有34例,男22例,女12例,年齡25—66歲,平均46.0歲。采用改良Stoppa入路治療為A組,共16例,其中以左側(cè)髂前切口為輔助入路1例,聯(lián)合髂脊切口固定髂骨翼7例;采用髂腹股溝入路治療,共18例,從中隨機抽取16例為B組,其中聯(lián)合K-L入路固定后柱或后壁4例,聯(lián)合髂脊切口固定髂骨翼1例,聯(lián)合臀后切口固定骶髂關節(jié)1例。兩組患者的性別、年齡、致傷因素、Letournel分型、合并傷、受傷后到手術(shù)時間等一般資料之間,差異均不具有統(tǒng)計學意義(P0.05)。通過對比兩組的切口長度、手術(shù)時間、術(shù)中出血量、術(shù)后引流量、X線Matta評分、術(shù)后第3、6、9個月的髖關節(jié)Harris評分來評價治療效果。結(jié)果:1、兩組手術(shù)時間、術(shù)中出血量、術(shù)后引流量以及在院時間,差異不具有統(tǒng)計學意義(P0.05)。2、改良Stoppa入路組的切口長度顯著短于髂腹股溝入路組,差異具有統(tǒng)計學意義(P0.05)。3、比較兩組術(shù)后影像學Matta評分,差異不具有統(tǒng)計意義(P0.05),但改良Stoppa入路組的復位滿意率高于髂腹股溝入路組。4、兩組術(shù)后第3、6、9月的Harris評分之間,差異不具有統(tǒng)計意義(P0.05),但是術(shù)后6、9月改良Stoppa入路組的良好率明顯高于髂腹股溝入路組。兩組Harris疼痛評分之間,差異均沒有統(tǒng)計學意義(P0.05)。5、術(shù)后并發(fā)癥:改良Stoppa入路組術(shù)后近期出現(xiàn)切口感染1例、切口脂肪液化1例,遠期未出現(xiàn)并發(fā)癥;髂腹股溝入路組近期無并發(fā)癥,遠期出現(xiàn)創(chuàng)傷性關節(jié)炎1例、股骨頭缺血性壞死1例。結(jié)論:1、應用改良Stoppa入路和髂腹股溝入路治療髖臼骨折,都能夠達到良好的臨床療效。2、在治療髖臼骨折中,改良Stoppa入路與經(jīng)典的髂腹股溝入路相比,具有手術(shù)切口小,鄰近組織損傷小,暴露良好,能直視四邊體,骨折復位精確質(zhì)量可靠,術(shù)后關節(jié)功能恢復良好,創(chuàng)傷性關節(jié)炎發(fā)病少等優(yōu)點。
[Abstract]:Objective: to compare the clinical effects of modified Stoppa approach and ilioinguinal approach in the treatment of acetabular fractures. Methods: from January 2011 to August 2016, 34 cases of acetabular fractures, 22 males and 12 females, aged 25-66 years (mean 46.0 years), were treated by anterior surgical approach in Fujian Provincial Hospital. 16 cases were treated with modified Stoppa approach, including 1 case with left anterior iliac incision, 7 cases with iliac pterygoid fixed by combined iliac spine incision, 18 cases treated by ilioinguinal approach, 16 cases were randomly selected as group B. The posterior column or posterior wall was fixed by combined K-L approach in 4 cases, iliac pterygoid was fixed with iliac spine incision in 1 case, sacroiliac joint was fixed with posterior buttock incision in 1 case. There was no significant difference between the two groups in terms of sex, age, cause factors of injury and Letournel classification, combined injury, and the time from injury to operation, etc. There was no significant difference between the two groups (P 0.05). The treatment effect was evaluated by comparing the incision length, operation time, intraoperative bleeding volume, postoperative drainage volume and X-ray Matta score, and the hip joint Harris score at the 3rd month and 9th month after operation. Results there was no significant difference in operative time, intraoperative bleeding volume, postoperative drainage volume and hospital time between the two groups. The length of incision in the modified Stoppa approach group was significantly shorter than that in the ilioinguinal approach group. The difference was statistically significant (P 0.05). There was no significant difference in Matta scores between the two groups, but the satisfaction rate of the modified Stoppa approach group was higher than that of the ilioinguinal approach group. The Harris scores of the two groups were higher than those of the ilioinguinal approach group, and the Harris scores of the 6th and 9th months after operation were higher in the modified Stoppa approach group than in the ilioinguinal approach group. The difference was not statistically significant, but the good rate of modified Stoppa approach group was significantly higher than that of ilioinguinal approach group 6 and 9 months after operation. There was no significant difference in Harris pain score between the two groups. The postoperative complications were as follows: in the modified Stoppa approach group, incision infection occurred in 1 case, incision fat liquefaction in 1 case, and there was no complication in the long term. In the ilioinguinal approach group, there were no complications, 1 case with traumatic arthritis and 1 case with avascular necrosis of femoral head. Conclusion the modified Stoppa approach and ilioinguinal approach are effective in the treatment of acetabular fractures. In the treatment of acetabular fractures, the modified Stoppa approach has a smaller operative incision than the classical ilioinguinal approach. The adjacent tissues have the advantages of small injury, good exposure, direct view of the quadrilateral body, accurate and reliable reduction of fracture, good recovery of joint function after operation, less incidence of traumatic arthritis and so on.
【學位授予單位】：福建中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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