前后入路与腹直肌外侧入路跨骶骨的髂骨间接骨板治疗骶髂关节脱位合并同侧骶骨翼骨折的效果对比研究

Efficacy comparison of the anterior-posterior approach and lateral rectus abdominis approach in the treatment of sacroiliac joint dislocation with ipsilateral sacral wing fracture

目的:对比前后入路与腹直肌外侧入路跨骶骨的髂骨间接骨板治疗骶髂关节脱位合并同侧骶骨翼骨折(SJDISWF)的效果。方法:回顾性分析2020年1月至2023年6月滕州市中心人民医院收治的81例SJDISWF患者的临床资料,根据手术入路方式分为腹直肌外侧入路组42例,前后入路组39例。对比两组患者的手术及恢复情况、骨折复位质量、疼痛情况、骨盆功能、骨代谢生化标志物及并发症发生率。结果:两组患者均获得7~12个月随访,平均(10.5±1.3)个月。腹直肌外侧入路组患者手术时间、术中出血量、切口长度、骨折愈合时间均优于前后入路组(P均<0.05)。两组患者术后骨折复位优良率比较,差异无统计学意义(P>0.05)。腹直肌外侧入路组患者术后3d、术后7d的疼痛视觉模拟评分均低于前后入路组(P均<0.05)。两组患者术后6个月骨盆功能优良率比较,差异无统计学意义(P>0.05)。两组患者术后6个月的骨钙素N端中分子片段(N-MID)、骨钙素(OC)、骨碱性磷酸酶(BAP)水平均高于术前(P均<0.05),腹直肌外侧入路组患者术后6个月的上述指标均高于前后入路组(P均<0.05)。两组患者术后6个月的并发症发生率比较,差异无统计学意义(P>0.05)。结论:腹直肌外侧入路与前后入路跨骶骨的髂骨间接骨板治疗SJDISWF的复位质量、骨盆功能恢复情况、安全性相近,但腹直肌外侧入路手术时间短、术中出血量少、切口小,可减轻患者术后疼痛,并有效改善术后骨代谢生化标记物N-MID、OC、BAP水平。

Objective:To compare the efficacy of the anterior-posterior and lateral rectus abdominis approaches in the treatment of sacroiliac joint dislocation with ipsilateral sacral wing fracture(SJDISWF).Methods:A retrospective analysis was conducted on the clinical data from 81 SJDISWF patients treated at Tengzhou Central People's Hospital from January 2020 to June 2023.Patients were divided into two groups based on the surgical approach:the lateral rectus abdominis group(42 cases)and the anterior-posterior group(39 cases).Surgical and recovery outcomes,quality of fracture reduction,pain level,pelvic function,biochemical markers of bone metabolism,and complication rates were compared between the two groups.Results:Both groups were followed up for 7-12 months,with an average of(10.5±1.3)months.The lateral rectus abdominis group had shorter operation time,less intraoperative blood loss,smaller incision length,and shorter fracture healing time compared to the anterior-posterior group(P<0.05).There was no statistically significant difference in the excellent rate of fracture reduction postoperatively between the two groups(P>0.05).The VAS scores of the lateral rectus abdominis group were lower than those of the anterior-posterior group on day 3 and day 7 post-surgery(both P<0.05).There was no statistically significant difference in the excellent rate of pelvic function at 6 months post-surgery between the two groups(P>0.05).The levels of osteocalcin mid-terminal fragment(N-MID),osteocalcin(OC),and bone alkaline phosphatase(BAP)were higher at 6 months postoperatively compared to preoperative levels in both groups(all P<0.05),with higher levels in the lateral rectus abdominis group compared to the anterior-posterior group(all P<0.05).There was no statistically significant difference in the complication rates between the two groups(P>0.05).Conclusions:The lateral rectus abdominis approach and the anterior-posterior approach for treating SJDISWF have similar outcomes in terms of reduction quality,pelvic functional recovery,and safety.However,the lateral rectus abdominis approach has advantages of shorter operation time,less intraoperative blood loss,smaller incision size,reduced postoperative pain,and increased postoperative bone metabolic markers N-MID,OC,and BAP levels.