改良Stoppa入路的內(nèi)固定術(shù)與外固定架治療骨盆前環(huán)骨折的療效比較

李玉祥　劉永　張英偉

[摘要] 目的 比較改良Stoppa入路的內(nèi)固定與外固定架治療骨盆前環(huán)骨折的臨床療效。 方法 選擇2012年1月～2016年6月在我院治療的骨盆前環(huán)骨折患者80例的臨床資料進(jìn)行回顧性分析。其中40例患者采用外固定架治療為外固定架組，40例患者采用改良Stoppa入路內(nèi)固定治療為內(nèi)固定組。比較兩組骨折復(fù)位質(zhì)量、臨床療效、手術(shù)切口長(zhǎng)度、平均手術(shù)時(shí)間、平均術(shù)中出血量、骨折愈合時(shí)間、并發(fā)癥發(fā)生率。 結(jié)果 內(nèi)固定組平均手術(shù)切口長(zhǎng)度較外固定組長(zhǎng)，術(shù)中出血量較外固定組多，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。內(nèi)固定組骨折復(fù)位滿意率為100.0%，顯著高于外固定組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。內(nèi)固定組臨床療效顯著優(yōu)于外固定組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。內(nèi)固定組骨折愈合時(shí)間顯著較外固定組短，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；兩組并發(fā)癥發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。 結(jié)論 改良Stoppa入路的內(nèi)固定治療骨盆前環(huán)骨折與外固定架比較創(chuàng)傷較大，但骨折復(fù)位質(zhì)量更好，臨床療效更佳。

[關(guān)鍵詞] 改良Stoppa入路；內(nèi)固定；外固定架；骨盆前環(huán)骨折

[中圖分類號(hào)] R683.3 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 1673-9701（2017）13-0068-03

[Abstract] Objective To compare the clinical efficacy between internal fixation via modified Stoppa approach and external fixator in the treatment of pelvic fracture. Methods The clinical data of 80 patients with pelvic fracture of the anterior ring treated in our hospital from January 2012 to June 2016 were retrospectively analyzed. 40 patients underwent external fixation and were chosen as external fixation group， and 40 patients underwent modified Stoppa approach for internal fixation and were selected as the internal fixation group.The fracture reduction quality， clinical efficacy，the length of the incision， the average operative time， the average intraoperative blood loss， the time of fracture healing and the incidence of complications were compared between the two groups. Results The average length of the incision in the internal fixation group was longer than that in the external fixation group， and the amount of bleeding in the internal group was more than that of the external fixation group， the difference was statistically significant（P<0.05）. The satisfaction rate of fracture reduction in internal fixation group was 100.0%， which was significantly higher than that in external fixation group，the difference was statistically significant（P<0.05）. The clinical curative effect of the internal fixation group was significantly better than that of the external fixation group（P<0.05）.The time of fracture healing in the internal fixation group was significantly shorter than that in the external fixation group，and the difference was statistically significant（P<0.05）. There was no significant difference in the incidence of complications between the two groups（P>0.05）. Conclusion The internal fixation with modified Stoppa approach is superior to the external fixator in the treatment of pelvic fracture of the anterior ring， but the fracture reduction quality and the clinical curative effect of the internal fixation are better.

[Key words] Modified Stoppa approach；Internal fixation；External fixator；Pelvic fracture of the anterior ring

骨盆骨折通常由高能外傷所導(dǎo)致，是一種嚴(yán)重的外傷，具有較高的致殘率，嚴(yán)重者甚至發(fā)生創(chuàng)傷性休克、失血性休克、盆腔臟器合并傷，如果治療不及時(shí)，甚至危及患者生命。切開復(fù)位內(nèi)固定術(shù)是目前治療骨盆骨折的理想方法，從根本上糾正骨盆骨折畸形，恢復(fù)骨折正常解剖結(jié)構(gòu)，通過牢固的內(nèi)固定，維持骨盆穩(wěn)定，以便于患者早期進(jìn)行功能鍛煉，減少并發(fā)癥的發(fā)生率以及死亡率[1，2]。盆骨前環(huán)骨折的固定方法包括手術(shù)內(nèi)固定以及外固定架治療。目前改良Stoppa入路是臨床上內(nèi)固定常用的骨盆前環(huán)骨折復(fù)位內(nèi)固定治療的入路方法，其腹膜外操作，手術(shù)視野清晰，便于暴露手術(shù)區(qū)，手術(shù)操作相對(duì)簡(jiǎn)單，術(shù)后神經(jīng)血管損傷風(fēng)險(xiǎn)小[3，4]。……