腹直肌旁入路与改良Stoppa入路治疗髋臼骨折的疗效分析

Analysis on the efficacy of pararectus approach and modified Stoppa approach in the treatment of acetabular fracture

目的了解腹直肌旁入路与改良Stoppa入路治疗髋臼骨折的疗效。方法髋臼骨折21例,其中11例(观察组)采用腹直肌入路治疗,10例(对照组)采用改良Stoppa入路治疗,记录两组的手术时间、术中出血量、骨折复位质量及髋关节功能评分。结果所有患者均获12~14.5个月的随访,平均随访时间12.5个月。观察组与对照组在骨折复位的术后影像学评分及术后髋关节功能评分等方面差异无统计学意义(P>0.05)。在手术时间及手术出血量上观察组明显少于对照组(P<0.01)。观察组术后无腹壁疝、重要神经及血管损伤等并发症发生;对照组有1例术后腹壁伤口脂肪液化,1例股神经麻痹。结论治疗涉及高位前柱的髋臼骨折及前柱骨折合并前壁或低位后柱的髋臼骨折,腹直肌旁入路明显优于改良Stoppa入路。

Objective To investigate the efficacy of pararectus approach and modified Stoppa approach in the treatment of acetabular fractures. MethodsThere were 21 cases of acetabular fractures collected, of which 11 cases（Observation Group） were treated with the pararectus approach and 10 cases（Control Group） were treated with the modified Stoppa approach. The operation time, intraoperative blood loss, the quality of fracture reduction and hip function score of the two groups were recorded. All the patients were followed up for 12 to 14.5 months, an average follow-up of 12.5 months. Results There was no significant difference in the postoperative radiographic score and postoperative hip function score between the Observation Group and the Control Group（P〉0.05）. The Observation Group had an operation time and operative bleeding volume significantly less than the Control Group（P〈0.01）. The observation Group had no such postoperative complications as abdominal wall hernia and significant nerve and vascular injury. In the control group, there was one case with postoperative fat liquefaction of abdominal wall wound and one case with femoral nerve palsy. The Conclusionpararectus approach was superior to the modified Stoppa approach in the treatment of high anterior column acetabular fracture and anterior column fracture complicated with anterior wall or low posterior column acetabular fracture.