腹直肌旁入路与髂腹股沟入路治疗髋臼骨折疗效比较

Comparison of clinical effects between pararectus versus ilioinguinal approach in the treatment of acetabular fractures

目的比较腹直肌旁入路与髂腹股沟入路治疗髋臼骨折的临床疗效。方法将2013年2月至2016年10月廉江市人民医院骨四科收治的65例髋臼骨折患者,根据随机数表法分为观察组33例和对照组32例。观察组经腹直肌旁入路治疗,对照组经髂腹股沟入路治疗,比较两组患者的切口长度、手术时间、术中出血量、术后并发症,术后随访1年,应用Matta标准评价髋关节骨折复位,Majeed标准评价术后功能恢复,SF-36生活质量评估量表评估术后生活质量。结果观察组和对照组患者切口长度[(6.91±1.31)cm vs(14.90±3.59)cm]、手术时间[(206.32±32.82)min vs(253.91±61.73)min]、术中出血量[(159.34±38.06)mL vs(320.68±51.09)mL]比较,差异均有统计学意义(P<0.05);观察组患者的术后并发症发生率为6.06%,明显低于对照组的18.75%,差异有统计学意义(P<0.05);观察组患者髋关节复位优良率为84.8%,功能恢复优良率为90.9%,均明显高于对照组的50.0%和59.4%,差异均有统计学意义(P<0.05);观察组患者术后的SF-36评分为(58.3±12.8)分,明显高于对照组的(46.7±9.4)分,差异有统计学意义(P<0.05)。结论腹直肌旁入路具有手术切口小、手术视野大、易于复位固定等优势,是髋臼骨折的较好入路选择。

Objective To compared the clinical effect between pararectus versus ilioinguinal approach in the treatment of acetabular fractures. Methods A total of 65 patients with acetabular fracture in the Fourth Department of Orthopedics, Lianjiang People＇s Hospital from February 2013 to October 2016 were randomly divided into observation group（n=33） and control group（n=32） according to the random number table method. The observation group was treated with pararectus approach, and the control group was given ilioinguinal approach treatment. The incision length, operative time, intraoperative bleeding volume, postoperative complications were compared between the two groups. The patients were followed up for 1 year. Matta criteria was used to evaluate the reduction of hip fracture, and Majeed standard was used to evaluate the postoperative functional recovery. The SF-36 scale was used to evaluate the quality of life after operation. Results The incision length, operative time, and intraoperative bleeding volume in observation group were（6.91±1.31） cm,（206.32±32.82） min, and（159.34±38.06） mL, respectively, which were significantly lower/shorter than（14.90 ± 3.59） cm,（253.91 ± 61.73） min, and（320.68 ± 51.09） mL in control group（P〈0.05）. The complication rate was6.06% in observation group, which was significantly lower than 18.75% in control group（P〈0.05）. The excellent rate of hip replacement and functional recovery in observation group were 84.8% and 90.9%, respectively, which were significantly higher than 50.0% and 59.4% in control group（P〈0.05）. After treatment, the SF-36 score in observation group was（58.3±12.8）, which was significantly higher than（46.7±9.4） in control group（P〈0.05）. Conclusion Pararectus versus approach has the advantages for small incision, large visual field, easy reduction and fixation, which is a better approach choice for acetabular fracture.