本文選題：MIPO技術(shù) + 髖臼�。� 參考：《河北醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:比較應(yīng)用MIPO技術(shù)與傳統(tǒng)的髂腹股溝入路手術(shù)治療骨盆與髖臼骨折的療效。方法:回顧性分析2013年1月-2014年12月在我科治療的23例骨盆與髖臼骨折患者的臨床資料,男性17例,女性6例,年齡25~62歲,平均年齡(44.17±9.69)歲。致傷因素:交通傷15例,墜落傷6例,擠壓傷2例。23例患者中,伴有多發(fā)傷10例,其中8例合并后環(huán)骨折,4例合并四肢骨折,3例合并胸腹部臟器損傷,2例合并尿道損傷,2例合并顱腦損傷。受傷至手術(shù)時(shí)間為3-15天,平均為(8.50±3.64)天。將23例患者分成A、B兩組,A組應(yīng)用MIPO技術(shù)治療的患者共11例,其中男性9例,女性2例,年齡33~61歲,平均年齡(42.82±8.17)歲,骨盆骨折4例,按Young-Burgess分型:APCⅢ型1例,LCⅡ型3例。髖臼骨折骨折7例,按Judet-Letournel分型:雙柱骨折4例,T型骨折2例,橫行骨折1例。治療方法:于患者髂骨和同側(cè)的恥骨上方分別做切口,先將移位的髂骨和髖臼前柱復(fù)位并用克氏針或螺釘行臨時(shí)固定,然后將鋼板從髂骨切口穿入,經(jīng)髂腰肌和髂血管的下方于恥骨上方的切口穿出(或者于恥骨上方的切口穿入,經(jīng)髂腰肌和髂血管的下方,然后在髂骨切口穿出),再將骨盆與髖臼的骨折進(jìn)行固定。7例髖臼骨折中,3例患者附加Kocher-Langen-beck入路復(fù)位并固定髖臼后柱骨折;B組應(yīng)用傳統(tǒng)的髂腹股溝入路手術(shù)治療的患者共計(jì)12例,其中男性8例,女性4例,年齡25~62歲,平均年齡(45.42±11.13)歲;骨盆骨折4例,按Young-Burgess分型:APCⅢ型1例,LCⅡ型1例,LCⅢ型2例。髖臼骨折骨折8例,按Judet-Letournel分型:雙柱骨折3例,T型骨折4例,橫行骨折1例。治療方法:采用經(jīng)典的髂腹股溝入路,需要游離髂腰肌、髂血管和精索(子宮圓韌帶),暴露“三個(gè)窗口”再將骨折進(jìn)行復(fù)位,然后在直視下將鋼板從髂腰肌和髂血管下穿過,并從恥骨聯(lián)合上切口穿出,固定骨盆和髖臼前柱骨折。8例髖臼骨折的患者中,4例患者附加Kocher-Langenbeck入路復(fù)位并固定髖臼后柱骨折;記錄兩組組患者的手術(shù)時(shí)間、術(shù)中出血量、術(shù)后引流量、術(shù)后功能及術(shù)后并發(fā)癥發(fā)生情況。術(shù)后骨盆骨折及髖臼骨折用Matta復(fù)位標(biāo)準(zhǔn)評(píng)定骨折復(fù)位的質(zhì)量。末次隨訪時(shí)采用改良的Merle D'Aubigne-Postel評(píng)分系統(tǒng)評(píng)定髖關(guān)節(jié)的功能。結(jié)果:⑴手術(shù)時(shí)間:A組為90~360min(不包括后環(huán)及其它部位骨折固定的時(shí)間),平均(171±81.6)min,B組為180~480min,平均為(293.4±96)min,A組的手術(shù)時(shí)間少于B組,差異有統(tǒng)計(jì)學(xué)意義,(P0.05);⑵術(shù)中出血量:A組為270~2000ml(不包括其它部位骨折固定的),平均(128.33±44.38)ml,B組為400~3000ml,平均(501.82±177.36)ml,A組的術(shù)中出血量少于B組,差異有統(tǒng)計(jì)學(xué)意義,(P0.05);⑶術(shù)后引流量:A組為20~150ml(不包括其它部位骨折固定的),平均(51.82±43.09)ml,B組為30~200ml,平均(105.83±47.19)ml,A組的術(shù)后引流量少于B組,差異有統(tǒng)計(jì)學(xué)意義,(P0.05);⑷骨折的復(fù)位質(zhì)量:A組骨盆骨折中復(fù)位滿意4例,復(fù)位不滿意0例,髖臼骨折中解剖復(fù)位3例,復(fù)位良好4例,復(fù)位差0例。B組骨盆骨折中復(fù)位滿意3例,復(fù)位不滿意1例,髖臼骨折中復(fù)位解剖復(fù)位5例,復(fù)位良好2例,復(fù)位差1例;⑸髖關(guān)節(jié)功能評(píng)分:A組優(yōu)3例,良好6例,可2例,差0例,B組優(yōu)3例,良好7例,可1例,差1例。二者的骨折復(fù)位質(zhì)量及末次隨訪的髖關(guān)節(jié)功能相比,無統(tǒng)計(jì)學(xué)意義,(P0.05);A組患者術(shù)后1例出現(xiàn)股外側(cè)皮神經(jīng)的癥狀,1例出現(xiàn)傷口淺表感染;B組患者術(shù)后2例出現(xiàn)股外側(cè)皮神經(jīng)損傷的癥狀,1例出現(xiàn)尿路感染,2例出現(xiàn)傷口淺表感染,1例出現(xiàn)股淺靜脈血栓,1例出現(xiàn)異位骨化。術(shù)后均未出現(xiàn)骨折不愈合、髖臼感染等并發(fā)癥;A組與B組相比,其術(shù)后并發(fā)癥較少,有統(tǒng)計(jì)學(xué)意義(P0.05)結(jié)論:應(yīng)用MIPO技術(shù)治療骨盆與髖臼前柱骨折創(chuàng)傷小、出血少、手術(shù)時(shí)間短、安全性高并可以不顯露股血管及股神經(jīng)等優(yōu)點(diǎn)。
[Abstract]:Objective: To compare the efficacy of MIPO and traditional iliac inguinal approach in the treatment of pelvic and acetabular fractures. Methods: a retrospective analysis of the clinical data of 23 patients with pelvic and acetabular fractures in December January 2013, -2014, in our department, 17 males, 6 women, age 25 ~62 years, average age (44.17 + 9.69) years. There were 15 cases of injury, 6 cases of falling injury, 2 cases of.23 and 10 cases of multiple injuries, of which 8 cases were combined with posterior ring fracture, 4 cases with limbs fracture, 3 cases with thoracic and abdominal organ injury, 2 cases with urethral injury, 2 cases with craniocerebral injury. The operation time was 3-15 days, the average was (8.50 + 3.64) days. The patients were divided into A, B two group, A group. 11 patients were treated with MIPO, including 9 males, 2 females, age 33~61, average age (42.82 + 8.17) years, 4 pelvic fractures, 1 cases of APC III, 3 of LC type II, 7 fracture of the acetabular fracture, 4 cases of double column fractures, 2 cases of T type fractures and 1 cases of transverse fractures. The iliac bone and the same side of the pubis are cut through the ilium and the anterior column of the acetabulum and temporarily fixed with Kirschner's pin or screw. Then the plate is penetrated through the iliac incision and through the incision above the pubis (or the incision on the suprapubic side) below the ilium and iliac vessels (or through the upper part of the pubis, below the ilium and iliac vessels. And then in the iliac incision, and then the pelvic and acetabular fractures were fixed for the.7 fracture of the acetabulum, 3 patients were added to the Kocher-Langen-beck approach and fixed the posterior column fracture; in group B, 12 patients were treated with traditional iliac inguinal approach, of which 8 were male, 4 women, age 25~62 years (45.42). 11.13 years of age, 4 cases of pelvic fracture, according to Young-Burgess type: 1 cases of type APC III, 1 cases of LC type II, 2 cases of type LC III, 8 cases of acetabular fracture, 3 cases of double column fracture, 4 cases of type fracture, 1 cases of transverse fracture. Treatment method: the treatment method: the iliocsoas muscle, iliac blood vessel and spermatic cord (round ligament), and the classical iliac inguinal approach were used. "Three windows" reposition the fracture and then cross the plate under the iliocsoas and iliac blood vessels under direct vision, through the joint incision of the pubis, and in the patients with the fracture of the acetabular fracture of the pelvis and the anterior column of the acetabulum in.8, 4 cases are attached and fixed the posterior column fracture of the acetabulum, and the two groups of patients are recorded. The operation time, intraoperative bleeding, postoperative flow rate, postoperative function and postoperative complications. Pelvic fracture and acetabular fracture were evaluated by Matta reduction criteria. The modified Merle D'Aubigne-Postel scoring system was used to evaluate the function of the hip joint during the last follow-up. Results: (1) the operation time: group A was 90~360mi N (171 + 81.6) min, group B was 180~480min, and group B was (293.4 + 96) min, and the operation time of group A was less than that of group B (P0.05); (2) the amount of bleeding in the operation: A group was 270~2000ml (not included in other parts of fracture), average (128.33 + 44.38) ml, B group was, Mean (501.82 + 177.36) ml, the amount of bleeding in group A was less than that in group B, the difference was statistically significant (P0.05); (3) postoperative flow rate: A group was 20~150ml (not including other parts of fracture fixed), average (51.82 + 43.09) ml, B group was 30~200ml, average (105.83 + 47.19) ml, A group was less than B group, the difference was statistically significant Fracture reduction quality: 4 cases of pelvic fracture in A group were satisfactory, 0 cases were dissatisfied, 3 cases were dissection in acetabular fracture, 4 cases were good reduction, 0 cases of.B group were satisfactory, 1 cases were dissatisfied, 5 cases of acetabular fracture, 2 cases of reduction, 1 cases of reduction and 1 cases, excellent 3 cases of A group. In 6 cases, there were 6 cases, 2 cases, 0 poor, 3 good in group B, 7 good, 1 and 1. No statistical significance was found in the fracture reduction quality of the two patients and the last follow-up of hip joint function (P0.05); in group A, 1 cases of the femoral lateral cutaneous nerve appeared in 1 cases, 1 cases appeared superficial infection of the mouth; and in group B patients after operation, 2 cases appeared thfemoral cutaneous nerve injury after operation. Symptoms, 1 cases of urinary tract infection, 2 cases of superficial wound infection, 1 cases of superficial femoral vein thrombosis, 1 cases of ectopic ossification. No postoperative fracture nonunion, acetabular infection and other complications, A group compared with group B, the postoperative complications were less, there was statistical significance (P0.05) conclusion: the application of MIPO technique for the pelvic and acetabular anterior column fracture creation of acetabular column treatment creation Less injury, less bleeding, shorter operation time, high safety and no exposure to femoral and femoral nerves.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

【引證文獻(xiàn)】

相關(guān)期刊論文 前1條

1 沈影超;王強(qiáng);顧云峰;蔣曉偉;;橋接鋼板技術(shù)治療不穩(wěn)定性髖臼骨折臨床效果分析[J];局解手術(shù)學(xué)雜志;2016年12期

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本文編號(hào)：1813539