微创小切口与髂腹股沟入路治疗Tile B型骨盆骨折临床疗效比较

The Effect Comparison of Internal Fixation of Locking Plate between Minimal Incision Approach and Ilioinguinal Approach for Pelvic Fracture with Tile B

目的比较前路微创小切口与传统髂腹股沟入路手术治疗Tile B型骨盆骨折的临床疗效。方法2014年6月~2017年12月回顾性分析行前路手术治疗的40例Tile B型骨盆骨折患者的临床资料,按手术入路分为两组:髂腹股沟入路组20例,采用传统髂腹股沟入路;微创小切口入路组20例,采用微创小切口入路。比较两组的临床疗效,评价标准包括手术时间,术中出血量,伤口愈合时间,术后使用止痛药的情况,随访影像学评价和Majeed临床评分。结果两组平均出血量、手术时间、伤口愈合时间及术后止痛药使用例数比较,微创小切口入路组均少于髂腹股沟入路组,差异有统计学意义(P<0.05)。术后两组均随访1年,至随访终末两组患者骨折均愈合,均未出现内固定失败。两组患者均于术后2~4月开始下地行走。髂腹股沟入路组骨折愈合时间平均2.9个月(2~4.5月),微创小切口入路组平均2.5个月(2~4),组间比较差异无统计学意义(P>0.05)。术后8月Majeed评分:髂腹股沟入路组优10例,良9例,可1例;微创小切口组优11例,良7例,可2例;两组优良率比较,差异无统计学意义(P>0.05)。术后髂腹股沟入路组出现股外侧皮神经麻痹4例,伤口感染或伤口渗出延迟愈合5例,微创入路组无并发症发生;两组并发症率比较,差异有统计学意义(χ2=11.61,P<0.01)。结论两种入路治疗Tile B型骨盆骨折术后功能评价无明显差异,但微创小切口术式具有创伤小、手术时间短、术中出血少、伤口愈合快和并发症发生率低等优点,值得临床推广应用。

To compare the clinical efficacy of internal fixation of locking plate via minimal incision anterior approach and anterior ilioinguinal approach for treatment of pelvic fracture with Tile B.Methods A total of 40 cases with Tile B pelvic fractures underwent open reduction and internal fixation of locking plate were analyzed retrospectively from June 2014 to December 2017.According to the surgical approach,all cases were divided into two groups:20 cases were performed the surgery via minimal incision anterior approach(as the mini-incision group),and the other 20 cases were carried out the surgery via anterior ilioinguinal approach(as the ilioinguinal group).Clinical evaluation involved the operation time,blood loss,wound healing time,administration of analgesic and Majeed score were compared between the two groups.Results The average blood loss,operation time,wound healing time and analgesic administration rate of the mini-incision group were less than those of the ilioinguinal group,and all the differences were significant statistically(P<0.05).All 40 cases were followed up for one year.All fractures were union without failure of internal fixation.Both groups achieved off-bed walking at 2 to 4 months after surgery.The average fracture union time was 2.9 months in the ilioinguinal group,and was 2.5 months in the mini-incision group,there was no obviously difference in the fracture union time between the two groups(P>0.05).The Majeed score revealed 10 of excellence,9 of good and 1 of fair in the ilioinguinal group and 11 of excellence,7 of good and 2 of fair in the mini-incision group,and there was no remarkable difference in the fineness rate between the two groups(P>0.05).The complication as lateral femoral cutaneous nerve paralysis was found in 4 cases and fracture delayed union due to wound infection or effusion in 5 cases in the ilioinguinal group,but no complications was found in the mini-incision group.The post-operative complication rate was higher of the ilioinguinal group than that of the mini-incision group(χ2=11.61,P<0.01).Conslusion Both the mini-incision approach and the ilioinguinal approach can achieve the same function assessment for the pelvic fractures,but the efficacy of the former approach appeared more advantages in mini-trauma,short operation time,less intra-operative blood loss,fast wound healing and lower complication incidence,and it is worthy of generalization.