高位髂腹股沟入路与改良Stoppa入路治疗骨盆骨折的疗效比较

Comparison efficacy of high ilioinguinal approach and modified Stoppa approach in the treatment of pelvic fractures

目的探讨高位髂腹股沟入路与改良Stoppa入路手术治疗骨盆骨折的临床疗效。方法将65例骨盆骨折患者根据手术入路方式不同分为A组(采用高位髂腹股沟入路,34例)和B组(采用改良Stoppa入路,31例)。比较两组的手术时间、切口长度、术中出血量、术后引流量、引流管拔除时间、住院时间、骨折复位质量及并发症发生情况。结果患者均获得随访,时间6～18个月。骨折均愈合良好。与B组比较,A组的手术时间和引流管拔除时间更短,切口更小,术中出血量和术后引流量更少,差异均有统计学意义(P<0.05)。两组住院时间及骨折复位满意率比较差异均无统计学意义(P>0.05)。A组有2例出现股外侧皮神经麻痹(5.9%),1例出现神经血管损伤(2.9%),B组有3例出现伤口液化(9.7%),1例出现股外侧皮神经麻痹(3.2%),1例出现深静脉血栓(3.2%),两组并发症发生率比较差异无统计学意义(P>0.05)。结论采用高位髂腹股沟入路与改良Stoppa入路手术治疗骨盆骨折均可获得较满意的疗效,但高位髂腹股沟入路操作更简单,创伤更小,更有利于患者恢复。

Objective To investigate the clinical effects of high ilioinguinal approach and modified Stoppa approach in the treatment of pelvic fractures. Methods The 65 patients were divided into two groups according to the different surgical approachs,group A was treated with high ilioinguinal approach（ 34 cases） and group B was treated with modified Stoppa approach（ 31 cases）. The operation time,incision length,intraoperative blood loss,postoperative drainage,removal time of drainage tube,hospitalization time,quality of fracture reduction and complications were compared between the two groups. Results All cases were followed up for 6 ～ 18 months,the fractures healed well.Compared with group B,the operation time and removal time of drainage tube in group A were shorter,the incision was smaller,the intraoperative blood loss and postoperative drainage were less,the differences were statistically significant（ P 0. 05）. There were no significant differences between the two groups in the hospitalization time and the satisfaction rate of reduction（ P 0. 05）. There were 2 cases of nervus cutaneus femoris lateralis paralysis（ 5. 9%）and 1 case of neurovascular injury（ 2. 9%） in group A. And in group B,there were 3 cases of wound liquefaction（ 9. 7%）,1 case of nervus cutaneus femoris lateralis paralysis（ 3. 2%） and 1 case of deep vein thrombosis（ 3. 2%）. However,there was no significant difference in the total complications rate between the two groups（ P 0. 05）. Conclusions Satisfactory curative effect can be achieved in the treatment of pelvic fractures via the high ilioinguinal approach and the modified Stoppa approach,but high iliac inguinal approach is simpler and less traumatic,which is more conducive to patient＇s recovery.