微创经骨膜外钢板内固定术与改良Stoppa入路手术治疗骨盆前环骨折效果比较
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摘要
目的比较微创经骨膜外钢板内固定术与改良Stoppa入路手术治疗骨盆前环骨折的效果。方法回顾性分析2013年1月—2017年6月我院创伤外科收治的50例骨盆前环骨折病人的临床资料,其中30例病人采用微创经骨膜外钢板内固定术(A组),20例病人采用改良Stoppa入路手术(B组)。比较两组病人的平均手术时间、术中出血量、住院时间、骨折复位优良率、术后肢体功能恢复优良率及术后并发症发生率。结果 A组病人平均手术时间和住院时间较B组短,平均术中出血量较B组少,差异均有统计学意义(t=2.48~12.92,P<0.05)。两组病人骨折复位优良率、术后肢体功能恢复优良率及术后并发症发生率比较差异均无统计学意义(P>0.05)。结论对于不稳定型骨盆前环骨折,微创经骨膜外钢板内固定术是一种操作简单、安全、疗效肯定的治疗方式。
Objective To investigate the efficacy of minimally invasive internal fixation via the parosteal approach versus modified Stoppaapproach in the treatment of anterior pelvic ring fracture. Methods A retrospective analysis was performed on the clinical data of 50 patients with anterior pelvic ring fractures who were admitted to the Department of Trauma Surgery,The Affiliated Hospital of Qingdao University,from January 2013 to June 2017.Of the 50 patients,30 underwent minimally invasive parosteal plate internal fixation(group A)and 20 underwent the internal fixation via the modified Stoppaapproach(group B).The following indices were compared between the two groups:mean operation time,mean intraoperative blood loss,mean length of hospital stay,the excellent and good rates of fracture reduction and limb functional recovery,and the incidence of postoperative complications. Results Group A had significantly shorter mean operation time and mean length of hospital stay and significantly less mean intraoperative blood loss than group B(t=2.48-12.92,P<0.05).There were no significant differences in the excellent and good rates of fracture reduction and limb functional recovery and the incidence of postoperative complications between the two groups(P>0.05). Conclusion For unstable anterior pelvic ring fractures,minimally invasive parosteal plate internal fixation is a simple and safe treatment with good efficacy.
Objective To investigate the efficacy of minimally invasive internal fixation via the parosteal approach versus modified Stoppaapproach in the treatment of anterior pelvic ring fracture. Methods A retrospective analysis was performed on the clinical data of 50 patients with anterior pelvic ring fractures who were admitted to the Department of Trauma Surgery,The Affiliated Hospital of Qingdao University,from January 2013 to June 2017.Of the 50 patients,30 underwent minimally invasive parosteal plate internal fixation(group A)and 20 underwent the internal fixation via the modified Stoppaapproach(group B).The following indices were compared between the two groups:mean operation time,mean intraoperative blood loss,mean length of hospital stay,the excellent and good rates of fracture reduction and limb functional recovery,and the incidence of postoperative complications. Results Group A had significantly shorter mean operation time and mean length of hospital stay and significantly less mean intraoperative blood loss than group B(t=2.48-12.92,P<0.05).There were no significant differences in the excellent and good rates of fracture reduction and limb functional recovery and the incidence of postoperative complications between the two groups(P>0.05). Conclusion For unstable anterior pelvic ring fractures,minimally invasive parosteal plate internal fixation is a simple and safe treatment with good efficacy.
引文
[1]BREUIL V,ROUX C H,CARLE G F.Pelvic fractures:epidemiology,consequences,and medical management[J].Current Opinion in Rheumatology,2016,28(4):442-447.
[2]LEI J Y,ZHANG Y,WU G Y,et al.The influence of pelvic ramus fracture on the stability of fixed pelvic complex fracture[J].Computational and Mathematical Methods in Medicine,2015,2015(4):1-11.
[3]李民,李书奎,陈汉文,等.新型改良Stoppa入路治疗髋臼并同侧骨盆骨折效果[J].齐鲁医学杂志,2016,31(5):584-586.
[4]叶阳春,熊志刚.改良Stoppa入路在骨盆与髋臼骨折治疗中的临床应用[J].中国骨与关节损伤杂志,2013,28(12):1161-1162.
[5]TILE M,HELFET D L,KELLAMS J F.Fractures of the pelvic and acetabulum[M].3rd.Philadelphia:Lippincott Williams&Wilkins,2003.
[6]HALAWI M J.Pelvic ring injuries:emergency assessment and management[J].Journal of Clinical Orthopaedics and Trauma,2015,6(4):252-258.
[7]HALAWI M J.Pelvic ring injuries:surgical management and long-term outcomes[J].Journal of Clinical Orthopaedics and Trauma,2016,7(1):1-6.
[8]DARMANIS S,LEWIS A,MANSOOR A,et al.Corona mortis:an anatomical study with clinical implications in approaches to the pelvis and acetabulum[J].Clinical Anatomy(New York,N.Y.),2007,20(4):433-439.
[9]MATTA J M,TORNETTA P 3rd.Internal fixation of unstable pelvic ring injuries[J].Clinical Orthopaedics&Related Research,1996(329):129-140.
[10]MAJEED S A.Grading the outcome of pelvic fractures[J].The Journal of Bone and Joint Surgery.British Volume,1989,71(2):304-306.
[11]郑炎,张超.应用骨盆外固定器治疗骨盆骨折的疗效分析[J].中外医学研究,2013,1(12):141.
[12]BULLER L T,BEST M J,QUINNAN S M.A nationwide analysis of pelvic ring fractures:incidence and trends in treatment,length of stay,and mortality[J].Geriatric Orthopaedic Surgery&Rehabilitation,2016,7(1):9-17.
[13]BORG T,HERNEFALK B,CARLSSON M,et al.Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury[J].Journal of Orthopaedic Surgery,2015,23(2):146-149.
[14]CALAFI L A,ROUTT M L.Anterior pelvic external fixation:is there an optimal placement for the supra-acetabular pin[J]?American Journal of Orthopedics(Belle Mead N.J.),2013,42(12):E125-E127.
[15]HIRVENSALO E,LINDAHL J,BOSTMAN O.A new approach to the internal fixation of unstable pelvic fractures[J].Clinical Orthopaedics and Related Research,1993,12(297):28-32.
[16]SAGI H C,AFSARI A,DZIADOSZ D.The anterior intrapelvic(modified Rives-Stoppa)approach for fixation of acetabular fractures[J].Journal of Orthopaedic Trauma,2010,24(5):263-270.
[17]刘勇,杨述华,杜靖远,等.采用下腹正中切口手术治疗骨盆前环复杂骨折[J].创伤外科杂志,2012,14(1):39-41.
[18]SHAZAR N,ESHED I,ACKSHOTA N,et al.Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic(modified Rives-Stoppa)surgical approaches[J].Journal of Orthopaedic Trauma,2014,28(6):313-319.
[19]MEI Z F,LEI W T,HUANG D H,et al.Modified stoppaapproach in treatment of bilateral pubic branch fractures[J].China Journal of Orthopaedics&Traumatology,2015,28(5):404.
[20]KHOURY A,WEILL Y,MOSHEIFF R.The stoppaapproach for acetabular fracture[J].Operative Orthopadie und Traumatologie,2012,24(4/5):439-448.
[21]ARCHDEACON M T,KAZEMI N,GUY P,et al.The modified Stoppaapproach for acetabular fracture[J].The Journal of the American Academy of Orthopaedic Surgeons,2011,19(3):170-175.
[22]LIU Z,WANG K,ZHANG K,et al.Minimally invasive surgery(MIS)of anterior ring fracture combined with public symphysis separation[J].Med Sci Monit,2014,20:1913-1917.
[23]APIVATTHAKAKUL T,RUJIWATTANAPONG N.“Anterior subcutaneous pelvic internal fixator(INFIX),is it safe?”A cadaveric study[J].Injury-International Journal of the Care of the Injured,2016,47(10):2077-2080.
[2]LEI J Y,ZHANG Y,WU G Y,et al.The influence of pelvic ramus fracture on the stability of fixed pelvic complex fracture[J].Computational and Mathematical Methods in Medicine,2015,2015(4):1-11.
[3]李民,李书奎,陈汉文,等.新型改良Stoppa入路治疗髋臼并同侧骨盆骨折效果[J].齐鲁医学杂志,2016,31(5):584-586.
[4]叶阳春,熊志刚.改良Stoppa入路在骨盆与髋臼骨折治疗中的临床应用[J].中国骨与关节损伤杂志,2013,28(12):1161-1162.
[5]TILE M,HELFET D L,KELLAMS J F.Fractures of the pelvic and acetabulum[M].3rd.Philadelphia:Lippincott Williams&Wilkins,2003.
[6]HALAWI M J.Pelvic ring injuries:emergency assessment and management[J].Journal of Clinical Orthopaedics and Trauma,2015,6(4):252-258.
[7]HALAWI M J.Pelvic ring injuries:surgical management and long-term outcomes[J].Journal of Clinical Orthopaedics and Trauma,2016,7(1):1-6.
[8]DARMANIS S,LEWIS A,MANSOOR A,et al.Corona mortis:an anatomical study with clinical implications in approaches to the pelvis and acetabulum[J].Clinical Anatomy(New York,N.Y.),2007,20(4):433-439.
[9]MATTA J M,TORNETTA P 3rd.Internal fixation of unstable pelvic ring injuries[J].Clinical Orthopaedics&Related Research,1996(329):129-140.
[10]MAJEED S A.Grading the outcome of pelvic fractures[J].The Journal of Bone and Joint Surgery.British Volume,1989,71(2):304-306.
[11]郑炎,张超.应用骨盆外固定器治疗骨盆骨折的疗效分析[J].中外医学研究,2013,1(12):141.
[12]BULLER L T,BEST M J,QUINNAN S M.A nationwide analysis of pelvic ring fractures:incidence and trends in treatment,length of stay,and mortality[J].Geriatric Orthopaedic Surgery&Rehabilitation,2016,7(1):9-17.
[13]BORG T,HERNEFALK B,CARLSSON M,et al.Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury[J].Journal of Orthopaedic Surgery,2015,23(2):146-149.
[14]CALAFI L A,ROUTT M L.Anterior pelvic external fixation:is there an optimal placement for the supra-acetabular pin[J]?American Journal of Orthopedics(Belle Mead N.J.),2013,42(12):E125-E127.
[15]HIRVENSALO E,LINDAHL J,BOSTMAN O.A new approach to the internal fixation of unstable pelvic fractures[J].Clinical Orthopaedics and Related Research,1993,12(297):28-32.
[16]SAGI H C,AFSARI A,DZIADOSZ D.The anterior intrapelvic(modified Rives-Stoppa)approach for fixation of acetabular fractures[J].Journal of Orthopaedic Trauma,2010,24(5):263-270.
[17]刘勇,杨述华,杜靖远,等.采用下腹正中切口手术治疗骨盆前环复杂骨折[J].创伤外科杂志,2012,14(1):39-41.
[18]SHAZAR N,ESHED I,ACKSHOTA N,et al.Comparison of acetabular fracture reduction quality by the ilioinguinal or the anterior intrapelvic(modified Rives-Stoppa)surgical approaches[J].Journal of Orthopaedic Trauma,2014,28(6):313-319.
[19]MEI Z F,LEI W T,HUANG D H,et al.Modified stoppaapproach in treatment of bilateral pubic branch fractures[J].China Journal of Orthopaedics&Traumatology,2015,28(5):404.
[20]KHOURY A,WEILL Y,MOSHEIFF R.The stoppaapproach for acetabular fracture[J].Operative Orthopadie und Traumatologie,2012,24(4/5):439-448.
[21]ARCHDEACON M T,KAZEMI N,GUY P,et al.The modified Stoppaapproach for acetabular fracture[J].The Journal of the American Academy of Orthopaedic Surgeons,2011,19(3):170-175.
[22]LIU Z,WANG K,ZHANG K,et al.Minimally invasive surgery(MIS)of anterior ring fracture combined with public symphysis separation[J].Med Sci Monit,2014,20:1913-1917.
[23]APIVATTHAKAKUL T,RUJIWATTANAPONG N.“Anterior subcutaneous pelvic internal fixator(INFIX),is it safe?”A cadaveric study[J].Injury-International Journal of the Care of the Injured,2016,47(10):2077-2080.