MIPPO技术在不稳定骨盆前环骨折治疗中的临床疗效分析
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摘要
近年来,骨盆前环骨折的发病率呈现上升趋势,而传统的固定方法效果较差,微创经皮钢板内固定(MIPPO)技术因其较好的治疗效果,广泛应用于临床实践中。为探讨MIPPO技术在不稳定型骨盆前环骨折治疗中的临床疗效,本研究选择了65例病例,随机分成MIPPO技术处理(实验组)和传统髂腹股沟入路(对照组)两组,对患者进行不稳定型骨盆骨折前环的手术治疗,由同一组医生完成。其中男31例,女34例;年龄31～64岁,平均年龄45.78岁。患者伤后至手术时间5～9 d,平均7.18 d。比较两组患者的并发症、手术时间、术中出血量、术后引流量、术后住院时间等数据,患者出院后1、4、8、12、24月复查骨盆X线片了解骨折愈合情况,骨折复位情况Matta评分和术后恢复情况Majeed评分。65例患者均获随访。实验组:手术时间(81.25±23.15) min,切口长度(6.95±1.05) cm,术中出血量(142.52±15.17) mL,术后引流量(65.25±8.45) m L,术后住院时间(10.31±1.30) d,骨折愈合时间(30.15±6.25) d;对照组:手术时间(104.15±25.25) min,切口长度(10.25±1.07) cm,术中出血量(174.43±23.15) mL,术后引流量(114.22±16.18) m L,术后住院时间(22.15±6.45) d,骨折愈合时间(47.25±7.15) d。两组在手术时间、切口长度、术中出血量、术后引流量、术后住院时间以及骨折愈合时间均存在显著差异(p<0.05)。实验组中DVT发生率以及总发生率与对照组有之间存在差异显著(p<0.05);而伤口感染和血管神经损伤方面差异不显著(p>0.05);再者,两组之间的骨折复位情况Matta评分和术后恢复情况Majeed评分差异不显著(p>0.05)。综上所述,与对照组相比,实验组较具有出血少、操作简单、住院时间短、切口小等特点,在骨折复位、固定及术后恢复方面具有相似的治疗效果,掌握一定的手术时机及技巧在不稳定骨盆骨折前环治疗中MIPPO微创钢板可以替换传统的切开复位方法。
In recent years, the incidence of anterior pelvic ring fractures was rising. However, traditional methods of fixed approaches didn't work well. Besides, minimally invasive percutaneous plate osteosynthesis(MIPPO) was widely used in clinical practice due to its good treatment effect in recent years. This study aims to evaluate the clinical effect of MIPPO technology in the treatment of unstable anterior pelvic ring fractures. 65 patients diagnosed with unstable anterior pelvic ring fractures were randomly assigned to be treated via MIPPO approach(experimental group) or traditional ilioinguinal approach(control group), which were treated by the same doctors.Including 31 males and 34 females with an average age of 45.78 years old, range from 31 to 64 years. The patients underwent surgery within a mean of 7.18 days, range from 5 to 9 days. The complications, duration of surgery,blood loss, postoperative drainage, healing time, hospitalization time after operation between the two groups were compared. Patients discharged from hospital after 1, 4, 8, 12, 24 months review pelvic X-ray to understand the fracture healing, and the fracture situation according to the Matta grades and postoperative recovery according to Majeed score. A total of 65 consecutive patients were evaluated. Experimental group: surgical duration(81.25±23.15) min,length of incision(6.95±1.05) cm, intraoperative blood loss(142.52 ±15.17) mL, postoperative drainage(65.25 ±8.45) mL, average hospitalization time after operation(10.31±1.30) days, fracture healing time(30.15±6.25) days.Control group: surgical duration(104.15±25.25) min, length of incision(10.25±1.07) cm, intraoperative blood loss(174.43±23.15) mL, postoperative drainage(114.22 ±16.18) mL, average hospitalization time after operation(22.15±6.45) days, fracture healing time(47.25±7.15) days. Comparison of the operative time, incision length,blood loss, postoperative drainage, average hospitalization time after operation and fracture healing time in two groups, the difference was statistically significant, p<0.05. Besides, there were significant differences in the incidence of DVT and total incidence rate between experimental group and control group, p<0.05. And no significant differences in wound infection, blood vessels and nerve injury, p>0.05. What is more, there were no significance in Matta evaluation criteria and Majeed score between the two groups, p>0.05. In general, Experimental group has the advantages of less bleeding, simple operation, small incision, shorter hospitalization time and other characteristics compared to control group. In the aspect of anterior pelvic fracture reduction, fixation, and postoperative recovery have similar efficacy. Mastery of the operation time and certain skills in the treatment of anterior unstable pelvic fractures, MIPPO can replace the traditional open reduction method.
In recent years, the incidence of anterior pelvic ring fractures was rising. However, traditional methods of fixed approaches didn't work well. Besides, minimally invasive percutaneous plate osteosynthesis(MIPPO) was widely used in clinical practice due to its good treatment effect in recent years. This study aims to evaluate the clinical effect of MIPPO technology in the treatment of unstable anterior pelvic ring fractures. 65 patients diagnosed with unstable anterior pelvic ring fractures were randomly assigned to be treated via MIPPO approach(experimental group) or traditional ilioinguinal approach(control group), which were treated by the same doctors.Including 31 males and 34 females with an average age of 45.78 years old, range from 31 to 64 years. The patients underwent surgery within a mean of 7.18 days, range from 5 to 9 days. The complications, duration of surgery,blood loss, postoperative drainage, healing time, hospitalization time after operation between the two groups were compared. Patients discharged from hospital after 1, 4, 8, 12, 24 months review pelvic X-ray to understand the fracture healing, and the fracture situation according to the Matta grades and postoperative recovery according to Majeed score. A total of 65 consecutive patients were evaluated. Experimental group: surgical duration(81.25±23.15) min,length of incision(6.95±1.05) cm, intraoperative blood loss(142.52 ±15.17) mL, postoperative drainage(65.25 ±8.45) mL, average hospitalization time after operation(10.31±1.30) days, fracture healing time(30.15±6.25) days.Control group: surgical duration(104.15±25.25) min, length of incision(10.25±1.07) cm, intraoperative blood loss(174.43±23.15) mL, postoperative drainage(114.22 ±16.18) mL, average hospitalization time after operation(22.15±6.45) days, fracture healing time(47.25±7.15) days. Comparison of the operative time, incision length,blood loss, postoperative drainage, average hospitalization time after operation and fracture healing time in two groups, the difference was statistically significant, p<0.05. Besides, there were significant differences in the incidence of DVT and total incidence rate between experimental group and control group, p<0.05. And no significant differences in wound infection, blood vessels and nerve injury, p>0.05. What is more, there were no significance in Matta evaluation criteria and Majeed score between the two groups, p>0.05. In general, Experimental group has the advantages of less bleeding, simple operation, small incision, shorter hospitalization time and other characteristics compared to control group. In the aspect of anterior pelvic fracture reduction, fixation, and postoperative recovery have similar efficacy. Mastery of the operation time and certain skills in the treatment of anterior unstable pelvic fractures, MIPPO can replace the traditional open reduction method.
引文
Ayhan A.,Dursun P.,Gultekin M.,and Yuce K.,2007,Comparison of midline and Pfannenstiel incision for radical hysterectomy with pelvic and paraaortic lymphadenectomy in cervical carcinoma,J.Obstet.Gynaecol.Res.,33(2):161-165
Gupta A.,Anjum R.,Singh N.,and Hackla S.,2015,Outcome of distal both bone leg fractures fixed by intramedulary nail for fibula&MIPPO in Tibia,Arch.Bone Jt.Surg.,3(2):119-123
Khaled S.A.,Soliman O.,and Wahed M.A.,2015,Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation:single versus two screw fixation,Eur.J.Trauma.Emerg.Surg.,41(4):387-392
Letournel E.,1993,The treatment of acetabular fractures through the ilioinguinal approach,Clin.Orthop.Relat.Res.,292:62-76
Li B.F.,Zhang Y.,Xia H.,Yin Q.S.,Li M.,Xie H.B.,Guo X.Z.,Xia Y.J.,Xiao J.,and Wang F.,2015,Modified Stoppa approach versus ilioinguinal approach in treatment of pelvic and acetabular fractures,Zhongguo Guke Linchuang Yu Jichu Yanjiu Zazhi(Chinese Journal of Clinical and Basic Orthopaedic Research),7(6):343-348(李宝丰,章莹,夏虹,尹庆水,李梅,谢会斌,郭晓泽,夏远军,肖进,王非,2015,改良Stoppa入路与髂腹股沟入路手术治疗骨盆髋臼骨折疗效比较,中国骨科临床与基础研究杂志,7(6):343-348)
Liu J.,Wei S.S.,Liu Y.,Yang S.H.,Du J.Y.,and Shao Z.W.,2011,The application of Stoppa approach in anterior pelvic ring fracture,Linchuang Jizhen Zazhi(Journal of Clinical E-mergency Call),12(4):246-248(刘佳,魏帅帅,刘勇,杨述华,杜靖远,邵增务,2011,采用Stoppa入路手术治疗骨盆前环骨折,临床急诊杂志,12(4):246-248)
Liu M.,Yang C.J.,Fang J.H.,Chen X.,and Yang J.,2017,Application of self-made pelvic bag in treatment for patients with unstable pelvic fracture,Xiandai Linchuang Huli(Modern Clinical Nursing),16(1):63-65(刘梅,杨春静,方加虎,陈曦,杨菁,2017,自制骨盆兜带在降低不稳定性骨盆骨折术前患者疼痛中的应用,现代临床护理,16(1):63-65)
Liu Q.J.,Chen W.,Lin B.,and Huang Z.Z.,2010,Minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation in treatment of proximal humeral comminuted fracture,Linchuang Guke Zazhi(Journal of Clinical Orthopaedics),13(2):160-162(刘庆军,陈卫,林斌,黄砖枝,2010,经皮微创锁定钢板内固定术与传统切开复位内固定术治疗肱骨近段粉碎性骨折疗效比较,临床骨科杂志,13(2):160-162)
Matta J.M.,and TornettaⅢP.,1996,Internal fixation of unstable pelvic ring injuries,Clin.Orthop.Relat.Res.,329:129-140
Saglam Y.,Dikmen G.,Bademler S.,Aksoy M.,and Dikici F.,2015,Analysis of the cause,classification,treatment,outcome and associated injuries of pediatric pelvic ring fractures,Ulus.Travma Acil Cerrahi Derg.,21(5):392-396
Yang B.,Li Q.,and Xie M.,2011,Analysis of curative effect of plate fixation with external fixation on unstable pelvic fracture,Xiandai Yufang Yixue(Modern Preventive Medicine),38(7):1364-1365(杨彬,李强,谢鸣,2011,钢板内固定联合外固定治疗不稳定型骨盆骨折的疗效分析,现代预防医学,38(7):1364-1365)
Zhang D.Y.,Yu K.,Dong S.L.,Li X.,Fu Z.G.,and Jiang B.G.,2013,Therapeutic effect of minimally invasive percutaneous plate osteosynthesis in treatment of anterior pelvic ring fractures,Zhonghua Chuangshang Zazhi(Chinese Journal of Trauma),29(1):33-37(张殿英,郁凯,董胜利,李响,付中国,姜保国,2013,微创经皮桥接钢板技术治疗骨盆前环骨折的疗效分析,中华创伤杂志,29(1):33-37)
Zhang F.Q.,Zhang Y.Z.,Pan J.S.,Peng A.Q.,Wu H.T.,Zhao L.L.,and Yao S.Q.,2005,Correlative study on pelvic fracture and artery injuries,Zhongguo Gu Yu Guanjie Sunshang Zazhi(Chinese Journal of Bone and Joint Injury),20(8):505-507(张奉琪,张英泽,潘进社,彭阿钦,吴昊天,赵立力,姚双权,2005,骨盆前环后环骨折与骨盆动脉损伤的相关性研究,中国骨与关节损伤杂志,20(8):505-507)
Zwingmann J.,Hauschild O.,Bode G.,Südkamp N.P.,and Schmal H.,2013,Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures:a systematic review and metaanalysis,Archives of Orthopaedic and Trauma Surgery,133(9):1257-1265
Gupta A.,Anjum R.,Singh N.,and Hackla S.,2015,Outcome of distal both bone leg fractures fixed by intramedulary nail for fibula&MIPPO in Tibia,Arch.Bone Jt.Surg.,3(2):119-123
Khaled S.A.,Soliman O.,and Wahed M.A.,2015,Functional outcome of unstable pelvic ring injuries after iliosacral screw fixation:single versus two screw fixation,Eur.J.Trauma.Emerg.Surg.,41(4):387-392
Letournel E.,1993,The treatment of acetabular fractures through the ilioinguinal approach,Clin.Orthop.Relat.Res.,292:62-76
Li B.F.,Zhang Y.,Xia H.,Yin Q.S.,Li M.,Xie H.B.,Guo X.Z.,Xia Y.J.,Xiao J.,and Wang F.,2015,Modified Stoppa approach versus ilioinguinal approach in treatment of pelvic and acetabular fractures,Zhongguo Guke Linchuang Yu Jichu Yanjiu Zazhi(Chinese Journal of Clinical and Basic Orthopaedic Research),7(6):343-348(李宝丰,章莹,夏虹,尹庆水,李梅,谢会斌,郭晓泽,夏远军,肖进,王非,2015,改良Stoppa入路与髂腹股沟入路手术治疗骨盆髋臼骨折疗效比较,中国骨科临床与基础研究杂志,7(6):343-348)
Liu J.,Wei S.S.,Liu Y.,Yang S.H.,Du J.Y.,and Shao Z.W.,2011,The application of Stoppa approach in anterior pelvic ring fracture,Linchuang Jizhen Zazhi(Journal of Clinical E-mergency Call),12(4):246-248(刘佳,魏帅帅,刘勇,杨述华,杜靖远,邵增务,2011,采用Stoppa入路手术治疗骨盆前环骨折,临床急诊杂志,12(4):246-248)
Liu M.,Yang C.J.,Fang J.H.,Chen X.,and Yang J.,2017,Application of self-made pelvic bag in treatment for patients with unstable pelvic fracture,Xiandai Linchuang Huli(Modern Clinical Nursing),16(1):63-65(刘梅,杨春静,方加虎,陈曦,杨菁,2017,自制骨盆兜带在降低不稳定性骨盆骨折术前患者疼痛中的应用,现代临床护理,16(1):63-65)
Liu Q.J.,Chen W.,Lin B.,and Huang Z.Z.,2010,Minimally invasive percutaneous plate osteosynthesis versus open reduction and internal fixation in treatment of proximal humeral comminuted fracture,Linchuang Guke Zazhi(Journal of Clinical Orthopaedics),13(2):160-162(刘庆军,陈卫,林斌,黄砖枝,2010,经皮微创锁定钢板内固定术与传统切开复位内固定术治疗肱骨近段粉碎性骨折疗效比较,临床骨科杂志,13(2):160-162)
Matta J.M.,and TornettaⅢP.,1996,Internal fixation of unstable pelvic ring injuries,Clin.Orthop.Relat.Res.,329:129-140
Saglam Y.,Dikmen G.,Bademler S.,Aksoy M.,and Dikici F.,2015,Analysis of the cause,classification,treatment,outcome and associated injuries of pediatric pelvic ring fractures,Ulus.Travma Acil Cerrahi Derg.,21(5):392-396
Yang B.,Li Q.,and Xie M.,2011,Analysis of curative effect of plate fixation with external fixation on unstable pelvic fracture,Xiandai Yufang Yixue(Modern Preventive Medicine),38(7):1364-1365(杨彬,李强,谢鸣,2011,钢板内固定联合外固定治疗不稳定型骨盆骨折的疗效分析,现代预防医学,38(7):1364-1365)
Zhang D.Y.,Yu K.,Dong S.L.,Li X.,Fu Z.G.,and Jiang B.G.,2013,Therapeutic effect of minimally invasive percutaneous plate osteosynthesis in treatment of anterior pelvic ring fractures,Zhonghua Chuangshang Zazhi(Chinese Journal of Trauma),29(1):33-37(张殿英,郁凯,董胜利,李响,付中国,姜保国,2013,微创经皮桥接钢板技术治疗骨盆前环骨折的疗效分析,中华创伤杂志,29(1):33-37)
Zhang F.Q.,Zhang Y.Z.,Pan J.S.,Peng A.Q.,Wu H.T.,Zhao L.L.,and Yao S.Q.,2005,Correlative study on pelvic fracture and artery injuries,Zhongguo Gu Yu Guanjie Sunshang Zazhi(Chinese Journal of Bone and Joint Injury),20(8):505-507(张奉琪,张英泽,潘进社,彭阿钦,吴昊天,赵立力,姚双权,2005,骨盆前环后环骨折与骨盆动脉损伤的相关性研究,中国骨与关节损伤杂志,20(8):505-507)
Zwingmann J.,Hauschild O.,Bode G.,Südkamp N.P.,and Schmal H.,2013,Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures:a systematic review and metaanalysis,Archives of Orthopaedic and Trauma Surgery,133(9):1257-1265