改良Stoppa入路内固定与外固定治疗骨盆前环骨折
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摘要
目的比较改良下腹正中切口(Stoppa入路)内固定与外固定治疗骨盆前环骨折患者的疗效。方法将40例患者分别采用改良Stoppa入路内固定(观察组,n=22)与外固定(对照组,n=18)治疗,比较两组骨折复位质量、骨盆功能恢复情况以及术后生活质量。结果患者均获得随访,时间36～39个月。观察组切口长度和出血量显著长(多)于对照组(P <0. 001),两组手术时间比较差异无统计学意义(P> 0. 05)。观察组骨折愈合时间显著短于对照组(P <0. 001),骨折复位满意率(21/22)显著高于对照组(12/18)(P=0. 017)。两组术后6、12、24、36个月Majeed功能评分、生活质量评分和VAS评分:组内不同时间点比较差异均有统计学意义(P <0. 05);组间不同时间点比较观察组均优于对照组,差异有统计学意义(P <0. 05)。两组随访期间均无骨折不愈合、畸形愈合、延迟愈合等现象发生,对照组出现3例钉道感染,两组术后并发症发生率比较差异无统计学意义(P=0. 165)。结论改良Stoppa入路内固定治疗骨盆前环骨折,创伤较外固定大,但骨折复位质量好,随访显示患者疼痛低、Majeed功能评分和生活质量评分高,疗效更好。
Objective To compare effect of internal fixation with modified Stoppa approach and external fixation for patients with anterior pelvic ring fracture. Methods Forty patients were treated with modified Stoppa approach( observation group,n = 22) and external fixation( control group,n = 18),the quality of fracture reduction,pelvic function recovery and postoperative life quality between the two groups were compared. Results All patients were followed up for 36 ～ 39 months. The incision length and bleeding volume in observation group were significantly longer( more) than these in the control group( P < 0. 001),and there was no significant difference in operation time between the two groups( P > 0. 05). The fracture healing time in observation group was significantly lower than that in the control group( P < 0. 001). The satisfaction rate of fracture reduction in observation group( 21/22) was significantly higher than control group( 12/18)( P = 0. 017). The Majeed functional score,life quality score and VAS at6,12,24,36 months after operation in observation group and the control group were significantly different( P <0. 05),the observation group was superior to the control group at different time points,and the differences were statistically significant( P < 0. 05). There was no fracture nonunion,malformation healing and delayed union in two groups,and there were 3 cases of nail infection in control group,the postoperative complication rate in observation group and control group had no significant difference( P = 0. 165). Conclusions The internal fixation with modified Stoppa approach for treating anterior pelvic ring fracture have much larger trauma than external fixation,but have beter fracture reduction quality,and follow-up shows low pain,high Majeed function score and life quality score with better long-term clinical efficacy.
Objective To compare effect of internal fixation with modified Stoppa approach and external fixation for patients with anterior pelvic ring fracture. Methods Forty patients were treated with modified Stoppa approach( observation group,n = 22) and external fixation( control group,n = 18),the quality of fracture reduction,pelvic function recovery and postoperative life quality between the two groups were compared. Results All patients were followed up for 36 ～ 39 months. The incision length and bleeding volume in observation group were significantly longer( more) than these in the control group( P < 0. 001),and there was no significant difference in operation time between the two groups( P > 0. 05). The fracture healing time in observation group was significantly lower than that in the control group( P < 0. 001). The satisfaction rate of fracture reduction in observation group( 21/22) was significantly higher than control group( 12/18)( P = 0. 017). The Majeed functional score,life quality score and VAS at6,12,24,36 months after operation in observation group and the control group were significantly different( P <0. 05),the observation group was superior to the control group at different time points,and the differences were statistically significant( P < 0. 05). There was no fracture nonunion,malformation healing and delayed union in two groups,and there were 3 cases of nail infection in control group,the postoperative complication rate in observation group and control group had no significant difference( P = 0. 165). Conclusions The internal fixation with modified Stoppa approach for treating anterior pelvic ring fracture have much larger trauma than external fixation,but have beter fracture reduction quality,and follow-up shows low pain,high Majeed function score and life quality score with better long-term clinical efficacy.
引文
[1] Rommens P M,Ossendorf C,Pairon P,et al. Clinical pathways for fragility fractures of the pelvic ring:personal experience and review of the literature[J]. J Orthop Sci,2015,20(1):1-11.
[2] Wong J M L,Bucknill A. Fractures of the pelvic ring[J]. Injury,2017,48(4):795-802.
[3]陈明,谢鸣,勘武生,等.不稳定型骨盆骨折的手术方式探讨[J].中华创伤骨科杂志,2013,15(5):445-447.
[4] Bastian J D,Ansorge A,Tomagra S,et al. Anterior fixation of unstable pelvic ring fractures using the modified Stoppa approach:mid-term results are independent on patients'age[J]. Eur J Trauma Emerg Surg,2016,42(5):645-650.
[5] Oh H K,Choo S K,Kim J J,et al. Stoppa approach for anterior plate fixation in unstable pelvic ring injury[J]. Clin Orthop Surg,2016,8(3):243-248.
[6] Meena S,Sharma P K,Mittal S,et al. Modified Stoppa approach versus ilioinguinal approach for anterior acetabular fractures; A systematic review and Meta-analysis[J]. Bull Emerg Trauma,2017,5(1):6-18.
[7] 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]. J Orthop Trauma,2014,28(6):313-319.
[8] Abu-Ramadan R,Qureshi Z A,Abdelrahim G A. Outcome of open reduction and internal fixation of traumatic unstable pelvic ring fractures[J]. P J M H S,2015,9(2):765-768.
[9] Bastian J D,Savic M,Cullmann J L,et al. Surgical exposures and options for instrumentation in acetabular fracture fixation:pararectus approach versus the modified Stoppa[J]. Injury,2016,47(3):695-701.
[10]李玉祥,刘永,张英伟.改良Stoppa入路的内固定术与外固定架治疗骨盆前环骨折的疗效比较[J].中国现代医生,2017,55(13):68-70.
[2] Wong J M L,Bucknill A. Fractures of the pelvic ring[J]. Injury,2017,48(4):795-802.
[3]陈明,谢鸣,勘武生,等.不稳定型骨盆骨折的手术方式探讨[J].中华创伤骨科杂志,2013,15(5):445-447.
[4] Bastian J D,Ansorge A,Tomagra S,et al. Anterior fixation of unstable pelvic ring fractures using the modified Stoppa approach:mid-term results are independent on patients'age[J]. Eur J Trauma Emerg Surg,2016,42(5):645-650.
[5] Oh H K,Choo S K,Kim J J,et al. Stoppa approach for anterior plate fixation in unstable pelvic ring injury[J]. Clin Orthop Surg,2016,8(3):243-248.
[6] Meena S,Sharma P K,Mittal S,et al. Modified Stoppa approach versus ilioinguinal approach for anterior acetabular fractures; A systematic review and Meta-analysis[J]. Bull Emerg Trauma,2017,5(1):6-18.
[7] 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]. J Orthop Trauma,2014,28(6):313-319.
[8] Abu-Ramadan R,Qureshi Z A,Abdelrahim G A. Outcome of open reduction and internal fixation of traumatic unstable pelvic ring fractures[J]. P J M H S,2015,9(2):765-768.
[9] Bastian J D,Savic M,Cullmann J L,et al. Surgical exposures and options for instrumentation in acetabular fracture fixation:pararectus approach versus the modified Stoppa[J]. Injury,2016,47(3):695-701.
[10]李玉祥,刘永,张英伟.改良Stoppa入路的内固定术与外固定架治疗骨盆前环骨折的疗效比较[J].中国现代医生,2017,55(13):68-70.