陳進(jìn)++馬俊昌++宋志會(huì)++陳思++袁鍵冰
[摘要]目的 探討改良Stoppa入路在骨盆骨折治療中的臨床效果。方法 選取我院2014年5月~2016年12月收治的60例骨盆骨折患者作為研究對(duì)象,隨機(jī)分為A組和B組,各30例。A組行髂腹股溝入路,B組行改良Stoppa入路。比較兩組的手術(shù)相關(guān)指標(biāo)及術(shù)后并發(fā)癥發(fā)生率。結(jié)果 B組的手術(shù)時(shí)間、住院時(shí)間、切口長(zhǎng)度短于A組,術(shù)中出血量少于A組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。B組的并發(fā)癥發(fā)生率為3.33%,低于A組的36.67%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 改良Stoppa入路在骨盆骨折治療中的臨床效果顯著,值得臨床推廣應(yīng)用。
[關(guān)鍵詞]骨盆骨折;手術(shù)時(shí)間;術(shù)中出血量;并發(fā)癥發(fā)生率
[中圖分類號(hào)] R683.3 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721(2017)04(c)-0059-03
[Abstract]Objective To explore the clinical effect of improved Stoppa approach in the treatment of pelvic fracture.Methods 60 patients with pelvic fractures from May 2014 to December 2016 admitted in our hospital were selected as research objects.They were randomly divided into group A and group B,30 cases in each group.In group A,iliac groin approach was used,while in group B,improved Stoppa approach was applied.The relevant surgical indexes and the incidence rate of postoperative complications in the two groups were compared.Results The operation time,hospitalization time,incision length in group B was shorter than that in group A,and the amount of intraoperative bleeding in group B was less than that in group A,with significant difference (P<0.05).The incidence rate of complication in group B was 3.33%,which was lower than 36.67% in group A,with significant difference (P<0.05).Conclusion Improved Stoppa approach is effective in the treatment of pelvic fracture and it is worthy of clinical promotion and application.
[Key words]Pelvic fracture;Operation time;Intraoperative blood loss;Incidence rate of complication
骨盆骨折為臨床中常見(jiàn)骨科疾病[1],保守治療效果較差,故臨床中多采取手術(shù)治療,其手術(shù)切口及復(fù)位質(zhì)量對(duì)患者術(shù)后的預(yù)后情況有較大影響[2],在手術(shù)過(guò)程中選擇合適的入路,予以適當(dāng)?shù)那锌诳商岣呤中g(shù)的成功率,改善其預(yù)后情況[3-4]。本研究旨在探討改良Stoppa入路在骨盆骨折治療中的臨床效果,現(xiàn)報(bào)道如下。
1資料與方法
1.1一般資料
選取我院2014年5月~2016年12月收治的60例骨盆骨折患者作為研究對(duì)象。納入標(biāo)準(zhǔn):①經(jīng)MRI、CT等診斷確診為骨盆骨折患者;②無(wú)手術(shù)禁忌證患者;③意識(shí)清楚、無(wú)認(rèn)知功能障礙患者;④愿意接受治療、隨訪患者。排除標(biāo)準(zhǔn):①凝血功能障礙患者;②嚴(yán)重肝腎功能不全患者;③認(rèn)知功能障礙且意識(shí)不清患者;④血管神經(jīng)損傷者;⑤不愿接受治療、隨訪的患者。采取信封式隨機(jī)分組法將入選患者分為A組和B組,各30例。A組中,男性20例,女性10例;年齡為24~69歲,平均(45.88±4.12)歲;致傷因素:交通事故傷者17例,高空墜落傷者10例,碾壓傷者3例。B組中,男性22例,女性8例;年齡為24~71歲,平均(46.34±4.55)歲;致傷因素:交通事故傷者18例,高空墜落傷者9例,碾壓傷者3例。兩組的性別、年齡及致傷因素等一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。
1.2方法
A組行髂腹股溝入路治療,采用腰部麻醉,患者取仰臥位,于髂脊前2/3處行切口[5],沿髂前上棘、腹股溝韌帶至恥骨上方3 cm方向,將髂肌、腹外斜肌腱相關(guān)附著點(diǎn)分離,將骶髂關(guān)節(jié)前方、腹股溝環(huán)上方完全暴露[6],將精索、圓韌帶、腹股溝神經(jīng)完全分開(kāi),將腹直肌鞘、聯(lián)合肌腱切斷,于腹股溝韌帶下方將髂腰肌、股神經(jīng)穿過(guò)牽引帶,牽開(kāi)暴露于空氣中的髖臼前柱、髂骨翼及四邊體。B組行改良Stoppa入路,采用腰部麻醉[7-8],患者取仰臥位,盡量不對(duì)膀胱造成傷害,將腹膜前間隙至恥骨的腹直肌鈍性分離,并予以牽拉,以便將腹壁下動(dòng)脈、閉孔動(dòng)脈找到,對(duì)其予以結(jié)扎,將髂腰筋膜打開(kāi)[1,9-10],將盆腔臟器向內(nèi)側(cè)牽拉,牽拉髂腰肌、下腹壁肌、髂外血管等組織至外側(cè),并將恥骨結(jié)節(jié)、坐骨棘、前骶髂關(guān)節(jié)顯露[11],于髂骨翼側(cè)入路,沿髂骨翼選擇弧狀切口,并對(duì)骨折處進(jìn)行固定[12],手術(shù)結(jié)束。兩組于術(shù)后均行抗感染治療,并對(duì)其進(jìn)行康復(fù)指導(dǎo)。