有限切开治疗骨盆骨折44例

Limited incisions for pelvic fractures in 44 cases

目的探讨有限切开入路治疗骨盆骨折的手术方式及其疗效。方法选择2008年1月-2011年11月44例骨盆骨折患者采取有限切开进行治疗，其中男31例，女13例；年龄21～70岁，平均38．3岁。骨折按Tile分型：TileB型25例（B111例，B214例），TileC型19例（C_1-2 14例，C_1-3 4例，C2 1例）。均采用手术治疗，其中单独采用Stoppa人路切开10例，Stoppa入路联合部分髂腹股沟入路切开13例；Stoppa入路联合后方微创入路切开13例；单独采用间断切开髂腹股沟入路切开5例；间断切开髂腹股沟入路联合后方微创入路切开3例。结果骨盆骨折前后环损伤患者术中复位均优（骨折部位分离〈4mm）。随访6—35个月，平均17个月所有患者均达到完全负重行走，x线片均提示骨性愈合。未出现骨折移位及内固定松动。有限切开入路的切口长度、平均手术时间、术中平均出血量均优于常规髂腹股沟入路。结论采用有限切开入路治疗骨盆骨折，具有手术操作简便、手术切口小、手术时间短、出血量少、并发症少的优点，是值得临床推广的手术方式。

Objective To investigate methods and curative outcomes of limited incision approach in treatment of pelvic fractures. Methods The study involved 44 patients suffering from pelvic fractures treated by limited incision from January 2008 to December 2011, including 31 males and 13 females, at age range of 21-70 years （average 38.3 years）. According to Tile classification, 25 cases were with type B fractures （I 1 of type B~ and 14 of type B2 ） , and 19 with type C fractures （ 14 with type C1_2, four with C1_3, one with type C2 ）. Surgical incision methods included simple Stoppa approach in 10 cases, Stoppa plus partial ilioinguinal approaches in 13, Stoppa approach plus posterior minimally invasive approaches in 13, discontinuous ilioinguinal approach in five, and discontinuous ilioinguinal plus posterior minimally invasive approaches in three. Results The patients with anterior and posterior pelvic ring injury achieved excellent reduction （separation of fracture sites 〈4 ram）. All patients could walk in full weight bearing during 6-35 months of follow-up （ average 17 months）. In the meantime, X-ray radiographs indicated bony union in all cases. There was no fracture displacement or implant loosening. Limited incision approach gained advantages of short incision length, short operation time and little intraoperative blood loss in comparison with traditional ilioinguinal approach. Conclusion Limited incision approach has merits of easy operation, small wounds, short operation time, minimal hemorrhage and few complications in treatment of pelvic fractures and thus is a surgery method worthy of clinical use.