【摘要】：目的:回顧性分析改良Stoppa入路結(jié)合髂窩入路治療的復雜四邊體骨折的臨床療效,為多樣化的臨床治療方案選擇提供有力參考。方法:回顧性分析我院骨科2012年9月-2016年9月間,經(jīng)同一組手術人員完成治療的復雜髖臼四邊體骨折患者資料43例,且完成隨訪,將所納入患者分為A、B兩組,A組患者采用改良Stoppa入路結(jié)合髂窩入路治療,B組患者采用髂腹股溝入路治療。A組患者中男15例,女9例,年齡51±4.7歲,根據(jù)Letournel-Judet髖臼骨折分型:雙柱骨折18例,前柱伴后半橫行4例,T形骨折1例,橫行骨折1例;B組中男12例,女7例,年齡49±5.2歲,Letournel-Judet髖臼骨折分型雙柱骨折13例,前柱伴后半橫行3例,T形骨折1例,橫行骨折2例。對比術前、術后患者的影像學資料,采用Matta標準來評價骨折復位質(zhì)量,同時記錄手術時間、術中出血量、術后并發(fā)癥以及末次隨訪患肢功能評分等,患肢功能評分采用改良的Merle d’Abubigne和Postel評分系統(tǒng)評定。兩組患者的一般資料對比差異無統(tǒng)計學意義(P0.05),具有可比性。結(jié)果:兩組患者均順利完成手術并獲得術后隨訪。A、B兩組患者手術時間分別為95±25分鐘、110±15分鐘,術中失血量分別為425±121.5毫升、725±175毫升,兩觀察指標間存在統(tǒng)計學意義(P0.05)。Matta骨折復位評價結(jié)果顯示:A組達到解剖復位(優(yōu))的患者15例,達到滿意復位(良)的患者6例,復位為不滿意(差)的患者3例,優(yōu)良率達87.5%;B組達到解剖復位(優(yōu))的患者12例,達到滿意復位(良)的患者4例,復位尚可(可)的患者2例,復位為不滿意(差)的患者1例,優(yōu)良率達84.2%,兩組患者間Matta骨折復位質(zhì)量無統(tǒng)計學差異(P0.05)。Merle d’Abubigne和Postel評分系統(tǒng)評定示:A組優(yōu)17例,良3例,一般1例,差3例,優(yōu)良率83.3%;B組優(yōu)11例,良4例,一般2例,差2例,優(yōu)良率78.9%,兩組患者髖關節(jié)功能評分無統(tǒng)計學差異(P0.05)。兩組患者并發(fā)癥發(fā)生率比較無統(tǒng)計學差異(P0.05)。結(jié)論:改良Stoppa入路結(jié)合髂窩入路在充分暴露四邊體骨折區(qū)及真骨盆緣區(qū)域具有明顯優(yōu)勢,可直視下復位并固定四邊體骨折,是治療復雜四邊體骨折的良好手術入路。改良Stoppa入路結(jié)合髂窩入路手術時間較短,損傷相對較小,術中出血量相對較低,完成骨折固定復位后可較早行術后功能鍛煉。對于老年患者發(fā)生復雜髖臼四邊體骨折情況,本身手術難度較大,應用該入路可在一定程度上降低手術難度,縮短患者術后恢復時間。而對于合并其他特殊類型復雜髖臼骨折可選擇同時聯(lián)合其他入路,如Kocher-Langenbeck入路輔助進行治療,臨床上也可取得較為滿意的結(jié)果。
[Abstract]:Objective: to analyze the clinical effect of modified Stoppa approach combined with iliofossa approach in the treatment of complex tetrahedral fractures, and to provide a powerful reference for the choice of various clinical treatment schemes. Methods: from September 2012 to September 2016, 43 patients with complex acetabular quadrangle fractures were treated by the same group of surgical personnel and were followed up. The patients in group A were divided into two groups: group A was treated with modified Stoppa approach combined with iliofossa approach, and group B was treated with ilioinguinal approach. In group A, there were 15 males and 9 females, aged 51 鹵4.7 years. According to Letournel-Judet acetabular fracture classification, there were 18 cases of double column fracture, 4 cases of anterior column with posterior half transverse fracture, 1 case of T shaped fracture and 1 case of transverse fracture. In group B, there were 12 males and 7 females, aged 49 鹵5.2 years. 13 cases of Letournel-Judet acetabular fracture were classified as double column fracture, 3 cases of anterior column with posterior half transverse fracture, 1 case of T-shaped fracture and 2 cases of transverse fracture. Compared with the imaging data of the patients before and after operation, the quality of fracture reduction was evaluated by Matta standard, and the operation time, intraoperative bleeding volume, postoperative complications and the functional score of the affected limbs were recorded at the same time. The functional scores of the affected limbs were evaluated by the improved Merle d'Abubigne and Postel scoring system. There was no significant difference in general data between the two groups (P 0.05), which was comparable. Results: the operation time of group A and group B was 95 鹵25 minutes and 110 鹵15 minutes, respectively, and the blood loss during operation was 425 鹵121.5 ml and 725 鹵175ml, respectively. there was statistical significance between the two indexes (P 0.05). The results of reduction evaluation of Matta fracture showed that 15 patients in group A achieved anatomical reduction (excellent) and 6 patients achieved satisfactory reduction (good). There were 3 patients with unsatisfactory (poor) reduction, the excellent and good rate was 87.5%. In group B, there were 12 patients with anatomical reduction (excellent), 4 patients with satisfactory reduction (good), 2 patients with satisfactory reduction (fair) and 1 patient with unsatisfactory (poor) reduction, the excellent and good rate was 84.2%. There was no significant difference in the reduction quality of Matta fracture between the two groups (P 0.05). Merle d'Abubigne and Postel scoring system evaluation showed that 17 patients in group A were excellent, 3 good, 1 general and 3 poor. The excellent and good rate was 83. 3%. In group B, 11 cases were excellent, 4 cases were good, 2 cases were general, 2 cases were poor, the excellent and good rate was 78.9%. There was no significant difference in hip function score between the two groups (P 0.05). There was no significant difference in the incidence of complications between the two groups (P 0.05). Conclusion: modified Stoppa approach combined with iliofossa approach has obvious advantages in fully exposed quadrangular fracture area and true pelvic margin area. It can be reduced and fixed under direct vision. It is a good surgical approach for the treatment of complex quadrangular fracture. The modified Stoppa approach combined with the ilium fossa approach has the advantages of short operation time, relatively small injury and relatively low amount of intraoperative bleeding. After the fracture fixation and reduction is completed, the postoperative functional exercise can be performed earlier. For the elderly patients with complex acetabular tetrahedral fracture, it is difficult to operate. The application of this approach can reduce the difficulty of operation to a certain extent and shorten the postoperative recovery time of the patients. For other special types of complex acetabular fractures, we can choose to combine with other approaches, such as Kocher-Langenbeck approach to assist in the treatment, and can also achieve satisfactory results in clinic.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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