腹直肌旁切口微创治疗地震伤骨盆骨折

Minimal invasive surgery of pelvic fractures sustained in earthquake through an incision near the rectus abdominis muscle

目的探讨应用腹直肌旁切口微创治疗地震伤骨盆骨折的方法及效果。方法对"8.03"鲁甸地震伤骨盆骨折9例均行腹直肌旁小切口(前环)钢板内固定或后环经皮骶髂拉力螺钉内固定,统计手术时间、切口长度、出血量、术前术后疼痛程度、复位效果、股外侧皮神经损伤情况及髋内收无力情况。结果地震伤骨盆骨折采用腹直肌旁手术入路内固定,手术操作简单、手术切口小、术中暴露范围广、手术时间短、出血少、损伤小、术后疼痛轻、骨折复位好、内固定稳定,无股外侧皮神经损伤及髋内收无力等并发症,治疗疗效满意。结论腹直肌旁手术入路微创治疗适合行前内侧固定的骨盆骨折,由于震区血源紧张,此方法特别值得广泛推广。

Objective To assess the effects of minimal invasive surgery through an incision near the rectus abdominis muscle for treatment of pelvic fractures sustained in earthquake. Methods Nine patients with pelvic fractures during Ludian earthquake（August 3, 2014） were treated with minimal invasive surgery through an incision near the rectus abdominis muscle followed by anterior ring fixation and reconstruction plate or posterior ring fixation with percutaneous sacroiliac lag screws. The operative time, incision length, blood loss volume, and pre- and postoperative pain levels were recorded. The surgical complications such as lateral femoral cutaneous nerve injury and hip adduction incapability were observed. Results The minimal invasive surgery achieved satisfactory clinical effects and allowed convenient operation with better surgical exposure,shorter operative time, less blood loss and pain. The patients showed excellent fracture reduction and stable internal fixation without lateral femoral cutaneous nerve injury or hip adduction incapability. Conclusions The minimal invasive surgery through an incision near the rectus abdominis muscle is suitable for treatment of pelvic fractures with anteriorly interior fixation, especially in rescuing victims in the event of an earthquake where blood supply can be very limited.