腹直肌外侧切口入路及三维数字化模型在同侧髋臼骨盆骨折的临床应用
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摘要
目的比较腹直肌外侧切口入路及三维数字化模型和传统髂腹股沟入路手术治疗同侧髋臼骨盆骨折的疗效。方法 2015年1月~2017年3月我院共收治118例同侧髋臼骨盆骨折患者,采用随机数字表分为两组,每组各59例,观察组采用腹直肌外侧切口入路与三维数字化模型,对照组采用传统髂腹股沟入路手术。比较两组手术时间、术中失血量、术后下地时间及并发症情况,术后定期复查X线,末次随访采用Majeed SA骨盆骨折评分系统评价其临床疗效。结果观察组手术时间短,术中失血量少,术后下地时间早,差异均有统计学意义(P>0.05)。118例患者均完成3个月随访,按Majeed SA评分评价疗效:观察组优43例,良8例,中6例,差2例,优良率86.4%;对照组优32例,良16例,中7例,差4例,优良率81.4%;两组优良率比较差异无统计学意义(P>0.05)。术后两组均无内固定或假体松动、断裂、髋内翻及深静脉血栓形成。观察组未发现严重并发症,对照组并发症共5例(8.5%),为坠积性肺炎、下肢深静脉血栓、手术区疼痛各1例,延迟愈合2例。组间并发症率比较,差异有统计学意义(χ~2=5.693,P=0.001)。结论同侧髋臼骨盆骨折患者采用腹直肌外侧切口入路及三维数字化模型可以缩短手术时间和术后下地时间,降低出血量、并发症率及手术风险,有利于术后功能康复。
Objective To compare the effect of lateral rectus abdominis incision approach combined three-dimensional digital model and traditional iliac groin approach for the treatment of acetabular pelvic fractures. Methods A total of 118 patients with acetabular pelvic fractures were enrolled in our hospital from January 2015 to March 2017. They were divided into two groups according to random digits table with 59 patients for each group: The observation group was treated by lateral rectus abdominis incision approach combined with 3 D digital model reconstruction,and the control group was performed surgery by traditional iliac groin approach. The operation time,intra-operative blood loss,normal activity time and post-operative complication incidence was compared between the two groups. The clinical result was evaluated by Majeed SA scoring system at last follow-up. Results Compare to the control group,the operation time was shorter,the intra-operative blood loss was less and the normal activity time was earlier in the observation group,and the difference was statistically( P > 0. 05). All 118 cases were followed up for 3 months. The curative effect was evaluatedaccording to Majeed SA score: The observation group was excellent in 43 cases,good in 8 cases,in 6 cases and poor in 2 cases,with an excellent rate of 86. 4%; The control group was excellent in 32 cases,good 16 cases,middle 7 cases,4 poor cases,with an excellent rate of 81. 4 %; And there was no statistical difference in the excellent rate between the two groups( P > 0. 05). There were no internal fixation or prosthesis loosening,rupture,coxa varus and deep vein thrombosis in both groups after operation. No serious complications were found in the observation group,but 5 cases( 8. 5 %) in the control group,including 1 case of hypostatic pneumonia,1 case of deep venous thrombosis of the lower extremity,1 case of pain in the surgical area and 2 cases of delayed union. There was statistical difference in complication rate between the two groups( χ2= 5. 693,P = 0. 001). Conclusion The lateral rectus abdominis incision approach and three-dimensional digital model reconstruction can shorten the operation time and the postoperative normal activity time,reduce the amount of bleeding,the incidence of complications and the risk of operation,and be beneficial to postoperative functional rehabilitation in the treatment of ipsilateral acetabular pelvic fracture.
Objective To compare the effect of lateral rectus abdominis incision approach combined three-dimensional digital model and traditional iliac groin approach for the treatment of acetabular pelvic fractures. Methods A total of 118 patients with acetabular pelvic fractures were enrolled in our hospital from January 2015 to March 2017. They were divided into two groups according to random digits table with 59 patients for each group: The observation group was treated by lateral rectus abdominis incision approach combined with 3 D digital model reconstruction,and the control group was performed surgery by traditional iliac groin approach. The operation time,intra-operative blood loss,normal activity time and post-operative complication incidence was compared between the two groups. The clinical result was evaluated by Majeed SA scoring system at last follow-up. Results Compare to the control group,the operation time was shorter,the intra-operative blood loss was less and the normal activity time was earlier in the observation group,and the difference was statistically( P > 0. 05). All 118 cases were followed up for 3 months. The curative effect was evaluatedaccording to Majeed SA score: The observation group was excellent in 43 cases,good in 8 cases,in 6 cases and poor in 2 cases,with an excellent rate of 86. 4%; The control group was excellent in 32 cases,good 16 cases,middle 7 cases,4 poor cases,with an excellent rate of 81. 4 %; And there was no statistical difference in the excellent rate between the two groups( P > 0. 05). There were no internal fixation or prosthesis loosening,rupture,coxa varus and deep vein thrombosis in both groups after operation. No serious complications were found in the observation group,but 5 cases( 8. 5 %) in the control group,including 1 case of hypostatic pneumonia,1 case of deep venous thrombosis of the lower extremity,1 case of pain in the surgical area and 2 cases of delayed union. There was statistical difference in complication rate between the two groups( χ2= 5. 693,P = 0. 001). Conclusion The lateral rectus abdominis incision approach and three-dimensional digital model reconstruction can shorten the operation time and the postoperative normal activity time,reduce the amount of bleeding,the incidence of complications and the risk of operation,and be beneficial to postoperative functional rehabilitation in the treatment of ipsilateral acetabular pelvic fracture.
引文
[1]赵飞,李岩,毕龙,等.3D打印骨折模型辅助治疗复杂骨盆骨折的长期随访研究[J].中华创伤杂志,2016,32(11):220-225.
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[7]Bastian JD,Tannast M,Siebenrock KA,et al.Mid-term results in relation to age and analysis of predictive factors after fixation of acetabular fractures using the modified Stoppa approach[J].Injury,2013,44(12):1793-1798.doi:10.1016/j.injury.2013.08.009.
[8]Briffa N,Pearce R,Hill AM,et al.Outcomes of acetabular fracture fixation with ten years'follow-up[J].J Bone Joint Surg Br,2011,93(2):229-236.doi:10.1302/0301-620X.93B2.24056.
[9]朱诗白,蒋超,叶灿华,等.3D打印技术在骨科领域的应用[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(1):88-93.
[10]王燎,戴尅戎.骨科个体化治疗与3D打印技术[J].医用生物力学,2014,29(3):193-199.
[11]胡林勇,陈秋生,钟美莲,等.3D打印在髋臼骨折并骨盆骨折中的临床应用[J].中华实用诊断与治疗杂志,2016,30(9):867-868.
[12]郭晓山.骨盆与髋臼骨折的治疗展望[J].中医正骨,2013,25(6):3-5.
[13]周伟力,雷青,张先家,等.3D打印技术在髋臼骨折手术中的临床应用[J].医学临床研究,2014,31(6):1097-1103.
[14]张潇,熊然,李涛,等.经腹直肌外侧切口入路治疗髋臼骨折的解剖学研究[J].中国临床解剖学杂志,2015,33(1):17-18.
[15]Keel MJ,Ecker TM,Cullmann JL,et al.The pararectus approach for anterior intrapelvic management of acetabular fractures:an anatomical study and clinical evaluation[J].J Bone Joint Surg Br,2012,94(3):405-411.doi:10.1302/0301-620X.94B3.27801.
[16]曾参军,谭新宇,黄华军,等.基于3D打印的腹直肌旁切口治疗骨盆骨折的临床疗效[J].南方医科大学学报,2016,36(2):220-225.
[17]庞骄阳,赵岩,肖宇龙.3D打印技术在脊柱外科的应用[J].中国组织工程研究,2016,20(4):577-578.
[2]唐靓,杨亚冬,罗涛,等.3D打印技术在医药卫生领域中的应用及研究进展[J].中国现代医生,2016,54(28):165-168.
[3]章凯,陈育岳,夏虹,等.3D打印技术辅助复杂性寰枢椎脱位手术临床应用[J].中国数字医学,2013,8(10):58-60.
[4]钱文彬,杨欣建,蓝涛,等.3D技术打印椎体在全脊椎整块切除术中应用的初步探索[J].生物骨科材料与临床研究,2015,12(2):9-11.
[5]魏新旺,杨志,姚军,等.3D打印技术在骨盆骨折修复中的应用[J].中国组织工程研究,2015,19(44):7163-7164.
[6]Isaacson MJ,Taylor BC,French BG,et al.Treatment of acetabulum fractures through the modified Stoppa approach:strategies and outcomes[J].Clin Orthop Relat Res,2014,472(11):3345-3352.doi:10.1007/s11999-014-3460-x.
[7]Bastian JD,Tannast M,Siebenrock KA,et al.Mid-term results in relation to age and analysis of predictive factors after fixation of acetabular fractures using the modified Stoppa approach[J].Injury,2013,44(12):1793-1798.doi:10.1016/j.injury.2013.08.009.
[8]Briffa N,Pearce R,Hill AM,et al.Outcomes of acetabular fracture fixation with ten years'follow-up[J].J Bone Joint Surg Br,2011,93(2):229-236.doi:10.1302/0301-620X.93B2.24056.
[9]朱诗白,蒋超,叶灿华,等.3D打印技术在骨科领域的应用[J].中华骨质疏松和骨矿盐疾病杂志,2016,9(1):88-93.
[10]王燎,戴尅戎.骨科个体化治疗与3D打印技术[J].医用生物力学,2014,29(3):193-199.
[11]胡林勇,陈秋生,钟美莲,等.3D打印在髋臼骨折并骨盆骨折中的临床应用[J].中华实用诊断与治疗杂志,2016,30(9):867-868.
[12]郭晓山.骨盆与髋臼骨折的治疗展望[J].中医正骨,2013,25(6):3-5.
[13]周伟力,雷青,张先家,等.3D打印技术在髋臼骨折手术中的临床应用[J].医学临床研究,2014,31(6):1097-1103.
[14]张潇,熊然,李涛,等.经腹直肌外侧切口入路治疗髋臼骨折的解剖学研究[J].中国临床解剖学杂志,2015,33(1):17-18.
[15]Keel MJ,Ecker TM,Cullmann JL,et al.The pararectus approach for anterior intrapelvic management of acetabular fractures:an anatomical study and clinical evaluation[J].J Bone Joint Surg Br,2012,94(3):405-411.doi:10.1302/0301-620X.94B3.27801.
[16]曾参军,谭新宇,黄华军,等.基于3D打印的腹直肌旁切口治疗骨盆骨折的临床疗效[J].南方医科大学学报,2016,36(2):220-225.
[17]庞骄阳,赵岩,肖宇龙.3D打印技术在脊柱外科的应用[J].中国组织工程研究,2016,20(4):577-578.