引流管应用与否在经改良Stoppa入路治疗骨盆骨折的对比研究

Is drainage necessary in pelvic fracture patients with modified Stoppa approach?

目的探讨经改良Stoppa入路治疗骨盆骨折是否放置引流管对预后的影响。方法回顾性分析2012年8月至2017年8月行改良Stoppa入路治疗骨盆骨折患者的病历资料,共43例患者纳入研究。男32例,女11例;年龄16~69岁,平均47.6岁。根据Young-Burgess分型,侧方挤压型LC-Ⅰ型12例;前后方压缩型APC-Ⅰ型20例,APC-Ⅱ型11例。所有患者均采用改良Stoppa入路复位骨折块并行钢板螺钉固定。按术中是否放置引流管进行分组,22例放置引流管(引流组),21例未放置引流管(非引流组)。主要观察指标为术中情况、抗生素应用、切口拆线时间、术后体温变化、住院时间及临床功能(Harris评分)等。结果两组患者术后均未发生感染,切口愈合良好。引流组抗生素使用时间为5.0 d(2.0,8.0)d,非引流组为4.0 d(2.0,5.0)d,差异无统计学意义(Z=1.161,P=0.924)。两组患者的住院时间分别为18.5 d(15.0,24.3)d和19.0 d(13.0,26.0)d,差异无统计学意义(Z=0.542,P=0.591)。引流组手术时间为(150.2±52.4)min,非引流组(138.8±41.2)min,差异无统计学意义(t=0.791,P=0.433)。引流组术中出血量为(604.6±387.3)ml,非引流组(581.0±275.0)ml,差异无统计学意义(t=0.276,P=0.784)。引流组与非引流组患者术后体温变化,第1天[(37.5±0.5)℃vs.(37.4±0.4)℃,t=0.322,P>0.05],第3天[(37.1±0.4)℃vs.(37.0±0.4)℃,t=0.286,P>0.05],第5天[(37.0±0.3)℃vs.(36.8±0.2)℃,t=2.127,P>0.05],第7天[(36.8±0.2)℃vs.(36.7±0.4)℃,t=0.491,P>0.05],差异均无统计学意义。切口拆线时间引流组为(14.1±0.6)d,非引流组(13.9±0.6)d,差异无统计学意义(t=1.072,P=0.329)。两组Harris评分分别为引流组96(91,100)分,非引流组96(93,97)分,差异无统计学意义(Z=0.107,P=0.607)。结论经改良Stoppa入路治疗骨盆骨折是否放置引流管对患者预后无明显影响。

Objective To investigate the effect of the placement of a drainage tube on the prognosis of patients with pelvic fractures treated by modified Stoppa approach.Methods The medical records of patients with pelvic fractures treated with modified Stoppa approach from August 2012 to August 2017 were retrospectively analyzed.A total of 43 patients including 32 males and 11 females(mean age 47.6 years,range from16 to 69)were included in the study.According to Young-Burgess classification,there were 12 cases of Lateral Compression type LC-I type;20 cases of Anterior and Posterior Compression type APC-I type and 11 cases of APC-II type.All patients were treated with modified Stoppa approach to reduce the fracture and fix with plate and screw.According to whether a drainage tube was placed during the operation,22 cases were placed with a drainage tube(drainage group),and 21 cases were not placed with a drainage tube(non-drainage group).The main observation indicators were the intraoperative conditions,antibiotic application,incision suture removal time,postoperative body temperature change,hospital stay and clinical function(Harris score).Results Wound infection was not observed in two groups.The duration of antibiotic use in the drainage group was 5.0 d(2.0,8.0)d,and the non-drainage group was 4.0 d(2.0,5.0)d,the difference was not statistically significant(Z=1.161,P=0.924).The hospital stays of the two groups were 18.5 d(15.0,24.3)d and 19.0 d(13.0,26.0)d,respectively,and the difference was not statistically significant(Z=0.542,P=0.591).The operation time was 150.2±52.4 min in the drainage group and 138.8±41.2 min in the non-drainage group,and the difference was not statistically significant(t=0.791,P=0.433).The blood loss in the drainage group was 604.6±387.3 ml,and the non-drainage group was 581.0±275.0 ml.The difference was not statistically significant(t=0.276,P=0.784).The postoperative body temperature changes of patients in the drainage group and non-drainage group were on day 1(37.5±0.5℃vs.37.4±0.4℃,t=0.322,P>0.05),day 3(37.1±0.4℃vs.37.0±0.4℃,t=0.286,P>0.05),day 5(37.0±0.3℃vs.36.8±0.2℃,t=2.127,P>0.05),on the 7th day(36.8±0.2℃vs.36.7±0.4℃,t=0.491,P>0.05),the difference was not statistically significant.The time for suture removal of surgical incision was 14.1±0.6 d in the drainage group and 13.9±0.6 d in the non-drainage group,and the difference was not statistically significant(t=1.072,P=0.329).The Harris scores of the two groups were 96(91,100)points for the drainage group and 96(93,97)points for the non-drainage group,and the difference was not statistically significant(Z=0.107,P=0.607).Conclusion There is no significant influence of the application of drainage on recovery of wound or function for patients with pelvic surgery.