髂腹股沟入路与改良Stoppa入路治疗骨盆合并髋臼骨折疗效及对患者围术期指标、Harris得分和并发症的影响

The efficacy of ilioinguinal approach and modified Stoppa approach in the treatment of pelvic fracture with acetabular fracture and their influence on perioperative indexes,Harris score and complications

目的探讨髂腹股沟入路与改良Stoppa入路治疗骨盆合并髋臼骨折疗效及对患者围术期指标、Harris得分和并发症的影响。方法108例骨盆合并髋臼骨折患者,按随机数字表法分为对照组和观察组各54例,均采用切开复位内固定手术治疗,观察组行与改良Stoppa入路治疗,对照组行髂腹股沟入路治疗,观察两组围手术期指标、术后1周的骨折复位效果和术后3个月的髋关节功能恢复效果,记录两组术后并发症情况,对比两组术前及术后3月的生活质量。结果观察组手术时间、切口长度、引流管拔除时间短于对照组,术中出血量、术后引流量少于对照组(P<0.05);术后1周骨折复位优良率和术后3月Harris评分优良率高于对照组(P<0.05);术后并发症总发生率低于对照组(P<0.05);术后3个月后,两组健康调查简表(SF-36)量表中关于总体健康、生命活力、健康状况、躯体功能及机体疼痛共5个维度评分显著提高(P<0.05),且观察组显著高于对照组(P<0.05)。结论改良Stoppa入路应用于骨盆合并髋臼骨折患者的切开复位内固定手术治疗中,能明显改善围手术期指标,提高患者骨折复位效果和髋关节功能,降低并发症发生风险,促进其生活质量改善,该入路疗效及安全性均优于髂腹股沟入路治疗。

Objective To explore the efficacy of ilioinguinal approach and modified Stoppa approach in the treatment of pelvic fracture with acetabular fracture and its influence on perioperative indexes,Harris score and complications.Methods One hundred and eight patients with pelvic fracture and acetabular fracture were randomly assigned to control or observation group,54 in each group.They were treated with open reduction and internal fixation.The observation group was treated with modified Stoppa approach while the control group was given ilioinguinal approach.The perioperative indexes,effects of fracture reduction after 1 week of surgery and recovery of hip function after 3 months of surgery were observed.The postoperative complications were recorded,and the quality of life was compared between the two groups before surgery and after 3 months of surgery.Results The surgical time,incision length and drainage tube removal time in the observation group were significantly shorter than those in the control group(P<0.05),and the intraoperative blood loss and postoperative drainage volume in the observation group were significantly less than those in the control group(P<0.05).The excellent and good rate of fracture reduction after 1 week of surgery and excellent and good rate of Harris score after 3 months of surgery in the observation group were significantly higher than those in the control group(P<0.05).The total incidence rate of postoperative complications in the observation group was significantly lower than that in the control group(P<0.05).After 3 months of surgery,the scores of five dimensions of overall health,vitality,health status,physical function and body pain short-form health survey(SF-36)scale in the two groups were significantly increased(P<0.05),and the scores in the observation group were significantly higher than those in the control group(P<0.05).Conclusion Modified Stoppa approach for open reduction and internal fixation in patients with pelvic fracture and acetabular fracture can significantly improve the perioperative indexes,improve the fracture reduction effects and hip function,reduce the risk of complications and promote the improvement of quality of life.The efficacy and safety of the approach are better than those of ilioinguinal approach.