改良K-L入路与腹直肌外侧入路手术在骨盆髋臼骨折患者中的应用效果比较

Comparison of the Application Effect of Modified K-L Approach and Lateral Rectus Abdominis Approach in Patients with Pelvic and Acetabular Fractures

目的比较改良Kocher-Langenbeck(K-L)入路与腹直肌外侧入路手术在骨盆髋臼骨折患者中的应用效果。方法回顾性收集河南省洛阳正骨医院2019年1月至2022年10月收治的80例完成切开复位内固定术的骨盆髋臼骨折患者临床资料,根据不同入路将80例患者分为改良K-L组(40例)和腹直肌外侧组(40例)。比较两组手术时间、术中出血量、骨折愈合时间,术后3 d时骨折复位质量,术前、术后3个月、术后6个月髋关节功能(Harris评分),术后6个月内并发症发生率。结果腹直肌外侧组手术时间短于改良K-L组,术中出血量少于改良K-L组,差异有统计学意义(P<0.05);两组骨折愈合时间时间比较,差异无统计学意义(P>0.05);腹直肌外侧组骨折复位优良率高于改良K-L组,差异有统计学意义(P<0.05);两组术前、术后3个月、术后6个月Harris评分比较,差异无统计学意义(P>0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论改良K-L入路和腹直肌外侧入路手术应用于骨盆髋臼骨折患者各有优劣,两种手术方式均可较好改善患者的髋关节功能,且术后并发症发生率较低,但腹直肌外侧入路可缩短手术时间,减少术中出血量,骨折复位质量更好。

Objective To compare the application effects of the modified Kocher-Langenbeck(K-L)approach and the lateral rectus abdominis approach in patients with pelvic and acetabular fractures.Methods Clinical data of 80 patients with pelvic and acetabular fractures who underwent open reduction and internal fixation at Luoyang Orthopedic-Traumatological Hospital of Henan Province from January 2019 to October 2022 were retrospectively collected.According to different approaches,80 patients were divided into the modified K-L group(40 cases)and the lateral rectus abdominis group(40 cases).The surgical time,intraoperative bleeding volume,fracture healing time,fracture reduction quality at 3 days after surgery,hip joint function(Harris score)were compared before surgery,3 months after surgery,and 6 months after surgery between the two groups,and the incidence of complications within 6 months after surgery were compared.Results The surgical time of the lateral rectus abdominis group was shorter than that of the modified K-L group,and the intraoperative bleeding was less than that of the modified K-L group,with statistical significant differences(P<0.05).There was no statistical difference in the healing time between the two groups of fractures(P>0.05).The excellent and good rate of fracture reduction in the lateral rectus abdominis group was higher than that in the modified K-L group,with statistical differences(P<0.05).There was no statistical difference in Harris scores between the two groups before surgery,3 months after surgery,and 6 months after surgery(P>0.05).There was no statistical difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion The modified K-L approach and the lateral rectus abdominis approach have their own advantages and disadvantages when applied to patients with pelvic and acetabular fractures.Both surgical methods can effectively improve hip joint function and have a low incidence of postoperative complications.However,the lateral rectus abdominis approach can shorten surgical time,reduce intraoperative bleeding,and improve the quality of fracture reduction.