腹直肌外侧入路治疗复杂骨盆、髋臼骨折的临床疗效研究

The Clinical Effect of Lateral Rectus Abdominis Approach in Treatment of Complex Pelvic and Acetabular Fractures

目的对比分析腹直肌外侧入路与髂腹股沟入路治疗复杂骨盆、髋臼骨折的临床疗效,探讨腹直肌外侧入路在复杂骨盆、髋臼骨折治疗中的应用价值。方法回顾性分析2015年1月至2019年1月我院采用腹直肌外侧入路或髂腹股沟入路治疗复杂骨盆、髋臼骨折的58例患者的临床资料。其中采用腹直肌外侧入路的患者28例(A组),采用髂腹股沟入路的患者30例(B组)。两组患者性别、年龄、骨折分型、病因等一般基线资料差异均无统计学意义(P>0.05),具有可比性。记录并比较两组患者切口长度、手术显露时间、术中出血量、早期并发症、髋关节功能评分、患者满意度,并对骨折复位情况行影像学评价。采用Matta影像学评估标准评估骨折复位质量,采用Merle D’Aubignéand Postel评分系统评估髋关节功能,采用简易Likert量表法评价患者满意度。结果所有患者均获随访,随访时间A组12~48个月,平均25.6个月,B组13~50个月,平均27.3个月,骨折均愈合。A组患者切口长度、手术显露时间、术中出血量、早期并发症、患者满意度方面明显优于B组,差异有统计学意义(P<0.05);髋关节功能评分及骨折复位质量方面,差异无统计学意义(P>0.05)。结论腹直肌外侧入路应用于复杂骨盆髋臼骨折具有切口长度短、手术显露时间短、术中出血量少、早期并发症少、患者满意度高等诸多优点,临床应用价值广,疗效优。

Objective To compare and analyze the clinical effects of lateral rectus abdominis approach and iliac-groin approach in the treatment of complex pelvic and acetabular fractures,and to explore the application value of lateral rectus abdominis approach in the treatment of complex pelvic and acetabular fractures.Methods From January 2015 to January 2019,clinical data of 58 patients with complicated pelvic and acetabular fractures treated by lateral rectus abdominis approach or iliac inguinal approach in our hospital were retrospectively analyzed.Among them,28 patients received the lateral rectus abdominis approach(group A),and30 patients received the iliac-groin approach(group B).There was no statistically significant difference in general baseline information between two groups,such as gender,age,fracture type,etiology(P>0.05).The incision length,surgical exposure time,intraoperative blood loss,early complications,hip joint function score,patient satisfaction were recorded and compared,and the fracture reduction was evaluated by imaging.The fracture reduction quality was evaluated by Matta imaging evaluation standard,the hip joint function was evaluated by Merle D’Aubignéand Postel scoring system,and patients’satisfaction was evaluated by simple Likert scale.Results All patients were followed up,Group A was followed up for 12-48 months with an average of 25.6 months,and group B was 13-50 months with an average of 27.3 months.The all fractures were healed.Group A was significantly better than group B in terms of incision length,surgical exposure time,intraoperative blood loss,early complications and patient satisfaction with statistically significant difference(P<0.05).There was no significant difference in hip joint function score and fracture reduction quality(P>0.05).Conclusion Lateral rectus abdominis approach is applied to complex pelvic and acetabular fractures that has many advantages such as short incision length,surgical exposure time,less intraoperative blood loss,less early complications and high patient satisfaction.It has a wide clinical application value and excellent curative effect.