改良Stoppa入路与髂腹股沟入路手术治疗骨盆髋臼骨折疗效比较

摘要

目的：比较改良Stoppa入路与髂腹股沟入路手术治疗骨盆髋臼骨折的疗效差异。方法回顾性分析2010年1月至2014年12月在广州军区广州总医院行手术治疗并获得完整随访的98例骨盆髋臼骨折患者的临床资料，其中改良Stoppa入路组48例、髂腹股沟入路组50例。临床评估指标包括手术切口长度、手术时间、出血量、骨折复位满意度、术后髋关节功能评分、手术并发症等。结果所有患者获6个月至5年随访（平均12个月）。改良Stoppa入路组和髂腹股沟入路组手术切口长度、手术时间、出血量分别为（9.2±2.7）cm和（15.1±4.3）cm、（1.7±0.7）h和（2.0±0.5）h、（545±230）mL和（721±156）mL，前者明显优于后者（P ＜0.05）。改良Stoppa入路组和髂腹股沟入路组复位优良率、末次随访Matta功能评分优良率分别为94%（45/48）和92%（46/50）、96%（46/48）和96%（48/50），两组比较，差异无统计学意义（P＞0.05）。改良Stoppa入路组术后深静脉血栓2例，髂腹股沟入路组切口浅表感染1例、深静脉血栓1例、股外侧皮神经麻痹3例、腹股沟疝1例；两组手术并发症发生率比较，差异有统计学意义（P＜0.05）。结论改良Stoppa入路手术治疗骨盆髋臼骨折效果可靠，与传统髂腹股沟入路相比，可以缩小手术切口、缩短手术时间、减少手术出血及术后并发症，在显露髋臼四边体、高位耻骨支及双侧骨盆髋臼损伤方面更具优势。%Objective To compare the differences of clinical efficacy between modified Stoppa and ilioinguinal approaches in the treatment of pelvic and acetabular fractures. Methods Clinical data of 98 patients with pelvic and acetabular fractures treated in Guangzhou General Hospital of Guangzhou Military Command from January 2010 to December 2014 with complete follow-up were retrospectively analyzed, in which 48 cases were treated by modified Stoppa approach, and other 50 cases treated by ilioinguinal approach. Clinical evaluation involved incision length, operative time, estimate blood loss volume, reduction of fractures, postoperative hip function scores, as well as postoperative complications. Results All patients were followed up for 6 months to 5 years (average, 12 months). The group of Stoppa approach was significantly superior to the ilioinguinal approach group in incision length [(9.2 ± 2.7) cm vs (15.1 ± 4.3) cm], operative time [(1.7 ± 0.7) h vs (2.0 ± 0.5) h] and estimate blood loss volume [(545 ± 230) mL vs (721 ± 156) mL], the difference between two groups had statistically significance (P <0.05). There were no statistically differences in reduction of fractures [the excellent and good rate of 94% (45/48) vs 92% (46/50), P >0.05] and hip function score [Matta standard, the excellent and good rate of 96% (46/48) vs 96% (48/50), P >0.05] at final follow-up. In modified Stoppa group, there were 2 cases of postoperative deep venous thrombosis; In ilioinguinal approach group, there were 1 case of superficial incision infection, 1 case of deep venous thrombosis, 3 cases of lateral femoral cutaneous nerve paralysis, and 1 case of inguinal hernia. The difference of complication rate between two groups had statistically significance (P <0.05). Conclusions Compared to ilioinguinal approach, the efficacy of procedure for pelvic and acetabular fractures by modified Stoppa approach is reliable, which has advantages of minimal invasiveness, short operation time, less blood loss, less complications, and sufficient exposure of quadrilateral surface, high superior ramus of pubis and bilateral pelvic and acetabular fractures.