腹直肌外侧切口入路行拉力螺钉内固定在髋臼前柱骨折中的临床应用

Clinical application of lateral rectus incision by lag screw internal fixation in the treatment of fracture of anterior column of acetabulum

目的:分析腹直肌外侧切口入路行拉力螺钉内固定治疗髋臼前柱骨折的疗效,探讨其临床适用性。方法:选择从2011年1月至2015年1月于惠州市第一人民医院就诊的22例行腹直肌外侧切口入路治疗的患者作为研究组,另选择同时期20例行常规髂腹股沟入路手术的患者作为对照组。观察两组患者的手术时间、术中出血量等手术一般情况及术后并发症情况,评价治疗后患者的骨折复位效果及髋关节功能评分情况。结果:研究组的手术时间和术中出血量分别为(2.11±0.39)h和(436.72±85.88)m L,均显著低于对照组的(2.99±0.41)h和(688.75±85.85)m L,差异具有统计学意义(P<0.05),两组患者术后均未出现切口感染、深静脉血栓形成等并发症。研究组术后出现1例合并坐骨神经损伤症状的患者,经过功能锻炼后6周内恢复正常,并发症发生率为4.55%(1/22);对照组出现1例切口处皮下脂肪液化,2例股外侧皮神经麻痹,1例下肢肌力障碍,2例出现异位骨化,对照组的总并发症发生率为30.0%(6/20),明显高于研究组(χ2=4.8 8 7 3,P=0.0 2 7 1),研究组患者骨折复位的优良率为95.45%,对照组为90.00%,两组差异无统计学意义(χ2=0.4 6 9 9,P=0.4 9 3 0)。治疗前两组患者的髋关节Ha r r i s评分比较无显著差异(6 8.7 2±9.1 8 v s.6 8.6 8±9.2 2,P>0.05),治疗后均显著升高(P<0.05),且研究组治疗后髋关节评分高于对照组患者(88.19±9.21 vs.79.16±9.24,P<0.05)。研究组的优良率为95.45%,对照组的优良率为85.00%,两组差异无统计学意义(χ2=1.3288,P=0.2490)。结论:腹直肌外侧切口入路行拉力螺钉内固定治疗髋臼前柱骨折疗效可靠,可以显著缩短手术时间,减少术中出血量,降低术后并发症,适合临床长期推广应用。

Objective： To analyze the clinical application of lateral rectus incision by lag screw internal fixation in thetreatment of fracture of anterior column of acetabulum. Methods： Twenty-two cases of rectus abdominis incision approach lag screw internal fixation were selected from January 2011 to January 2015 in our hospital for treatment as a study group, and in the same period, the other 20 routine ilioinguinal approach surgery patients were selected as a control group. The operation time and a amount of bleeding of the two groups were observed, and the postoperative complications were evaluated, and the effect of fracture reduction and hip function score were evaluated. Results： The operative time and blood loss of patients in the study group [（2.11±0.39） h and （436.72±85.88） mL] were significantly lower than those in control group [（2.99±0.41） h and （688.75±85.85） mL], the differences were statistically significant （P〈0.05）; there were no incision infection, deep vein thrombosis formation in the two groups of patients. One case were with sciatic nerve injury symptoms in study group, after 6 weeks of exercise then to be normal, the complication rate was 4.55% （1/22）; in the control group, 1 case of incision fat liquefaction, 2 cases of lateral femoral cutaneous nerve paralysis, 1 case of lower extremity muscle force disorder, 2 cases of heterotopic ossification, and total incidence rate of the complications in the control group of patients was 30% （6/20）, which was significantly higher than that of the study group, the difference was statistically significant （X2=4.8873, P=0.0271）. The excellent rate of fracture reduction in the study group was 95.4S%, while in the control group it was 90.00%, the difference has no statistical significance （X2=0.4699, P=0.4930）. Before treatment, Harris score of the hip joint in two groups was no significantly different （68.72±9.18 vs. 68.68±9.22, P〉0.0S）; after treatment, Harris score both significantly increased （P〈0.05）, and the improvement of the study group patients were higher than that in the control group （88.19±9.21 vs. 79.16±9.24, P〈0.0S）. The excellent rate of the study group was 95.45%, and of the control group it was 85%. There was no significant difference between the two groups （x=1.3288, P=0.2490）. Conclusion： Lateral rectus incision for lag screw internal fixation in the treatment of acetabular anterior column fracture is reliable, can significantly shorten the operation time, reduce intraoperative blood loss and postoperative complications, which is suitable for long-term clinical application.