摘要目的: 探讨髂腹股沟入路、改良Stoppa入路和腹直肌旁入路治疗骨盆髋臼骨折的疗效。方法: 回顾性分析2020年8月至2022年8月在本院收治的骨盆髋臼骨折患者资料,依照手术治疗方案不同分为三组,即选择髂腹股沟入路病人为A组,选择改良Stoppa入路病人为B组,选择腹直肌旁入路病人为C组,经倾向性匹配评分法最终得出,A、B组均为50例,C组52例,三组基线资料对比差异无统计学意义(P>0.05)。对比三组一般手术情况、术后住院时间、术后7d骨折复位质量、不同时间点(术前、出院时以及术后6个月末次随访)的髋关节功能(改良Merle D' Aubigne and Postel评分系统)以及术后并发症发生情况。结果: 三组显露骨折端时间、术中出血量、术后Hb对比差异有统计学意义(P<0.05),其中B、C组显露时间显著短于A组(P<0.05),术中出血量显著少于A组(P<0.05),术后Hb显著高于A组(P<0.05),B、C组间上述手术指标对比差异无统计学意义(P>0.05);三组术后7d骨折复位质量优良率对比差异无统计学意义(P>0.05),C组的优良率虽高于A、B组,但两两组间对比差异无统计学意义(P>0.05);出院时以及术后6个月末次随访时,三组Postel评分逐渐提高,三组时间点效应对比有统计学意义(P<0.05);三组组间效应以及时间点与组间交互效应对比,差异均无统计学意义(P>0.05),三组出院时及术后6个月末次随访时Postel评分均高于术前(P<0.05);三组术后总并发症率对比差异有统计学意义(P<0.05),其中C组显著低于A组(9.62%vs36.00%,P<0.05)。结论: 3种手术入路的钢板内固定术治疗骨盆髋臼骨折均能达到良好骨折复位质量,恢复髋关节功能,但改良Stoppa入路和腹直肌旁入路术中显露时间、出血量及术后Hb效果优于髂腹股沟入路,而腹直肌旁入路的骨折复位优良率高于其他2种入路,且并发症更少。
Abstract：Objective: To explore the efficacy of ilioinguinal approach, modified Stoppa approach and parabdominis rectus approach in the treatment of pelvic and acetabular fractures. Methods: The data of patients with pelvic and acetabular fractures in the hospital from August 2020 to August 2022 were retrospectively analyzed, and the patients were classified into three groups according to the different regimens. Patients with ilioinguinal approach were selected as group A, patients with modified Stoppa approach were included in group B, and patients with parabdominis rectus approach were enrolled as group C. According to the propensity matching scoring method, 50 cases in group A, 50 cases in group B, and 52 cases in group C were finally obtained. There were no statistical differences among the three groups in terms of baseline data (P>0.05). The general surgery, postoperative hospital stay, quality of fracture reduction at 7 days after surgery, hip function (modified Merle D’ Aubignéand Postel scoring system) at different time points (before surgery, at discharge and at the last follow-up at 6 months after surgery) and occurrence of postoperative complications were compared among the three groups. Results: There were statistically significant differences in fracture end exposure time, intraoperative blood loss and postoperative Hb among the three groups (P<0.05). The exposure time in groups B and C was obviously shorter compared with that in group A (P<0.05), and the intraoperative blood loss was significantly less (P<0.05), and the postoperative Hb was significantly higher (P<0.05), but there were no statistical differences in the above surgical indicators between group B and group C (P>0.05). There was no statistically significant difference in the excellent and good rate of fracture reduction quality among the three groups at 7 days after surgery (P>0.05). Although the excellent and good rate in group C was higher than that in group A and group B, there was no statistical difference between the two groups (P>0.05). At discharge and at the last follow-up at 6 months after surgery, the Postel score of the three groups was gradually improved, and there was a statistical significance from the aspect of time-point effect among the three groups (P<0.05), but there was no statistical difference in the score from the aspects of between-group effect and interaction effect of between-group and time-point (P>0.05). The Postel score in the three groups at discharge and at the last follow-up at 6 months after surgery was higher than that before surgery (P<0.05). The total postoperative complication rate was significantly different in the three groups (P<0.05), and the rate in group C was significantly lower than that in group A (9.62% vs 36.00%, P<0.05). Conclusion: All three kinds of plate internal fixation in the treatment of pelvic and acetabular fractures can achieve good fracture reduction quality and restore hip function, but modified Stoppa approach and parabdominis rectus approach have better effects on exposure time, blood loss and postoperative Hb than ilioinguinal approach, and parabdominis rectus approach has a higher excellent and good rate of fracture reduction than the other two approaches and fewer complications.
2023, Vol. 29 
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