前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折的临床疗效及安全性分析
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摘要
目的探讨前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折的临床疗效及安全性。方法我院骨科收治的66例复杂髋臼骨折患者,根据手术方式不同将分为对照组和观察组各33例。对照组采取前路钛板加方形区螺钉手术治疗,观察组采取前路钛板加方形区螺钉联合改良后柱螺钉手术治疗。观察两组围手术期情况、髋关节复位及功能情况、术后并发症发生情况。结果观察组手术时间、术中出血量少于对照组,髋关节复位优良率及功能评分高于对照组(P <0. 05);两组术后并发症总发生率比较,差异无统计学意义(P> 0. 05)。结论前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折的临床疗效显著,具有手术时间短、术中出血量少及安全性高等优点,具有较高临床应用价值。
Objective To analyze the clinical efficacy and safety of anterior titanium plate plus square screw combined with modified posterior screw in the treatment of complex acetabular fractures.Methods Sixty-six patients with complicated acetabular fractures in our hospital were selected. According to the different surgical methods,the patients were divided into control or observation group,33 in each group.The control group was treated with anterior titanium plate plus square screw,and the observation group was treated with anterior titanium plate plus square screw and modified posterior screw. The perioperative conditions,hip joint restoration and functional status,and postoperative complications were observed.Results The operation time,blood loss during the operation,excellent rate of hip joint restoration and hip function score in the observation group were shorter or less or better than those in the control group( P < 0. 05).There was no significant difference in the incidence of postoperative complications between the two groups( P > 0. 05).Conclusion The application of anterior titanium plate plus square screw combined with modified posterior posterior screw in the treatment of complex acetabular fractures has significant clinical effects,with advantages of shorter operation time,less intraoperative blood loss and high safety.It has high clinical application value.
Objective To analyze the clinical efficacy and safety of anterior titanium plate plus square screw combined with modified posterior screw in the treatment of complex acetabular fractures.Methods Sixty-six patients with complicated acetabular fractures in our hospital were selected. According to the different surgical methods,the patients were divided into control or observation group,33 in each group.The control group was treated with anterior titanium plate plus square screw,and the observation group was treated with anterior titanium plate plus square screw and modified posterior screw. The perioperative conditions,hip joint restoration and functional status,and postoperative complications were observed.Results The operation time,blood loss during the operation,excellent rate of hip joint restoration and hip function score in the observation group were shorter or less or better than those in the control group( P < 0. 05).There was no significant difference in the incidence of postoperative complications between the two groups( P > 0. 05).Conclusion The application of anterior titanium plate plus square screw combined with modified posterior posterior screw in the treatment of complex acetabular fractures has significant clinical effects,with advantages of shorter operation time,less intraoperative blood loss and high safety.It has high clinical application value.
引文
[1]邵晏清,熊然,张潇,等.良stoppa切口入路与腹直肌外侧入路治疗合并骨盆骨折的髋臼骨折的疗效比较[J].医学综述,2016,22(2):380-382.
[2]麦奇光,谷诚,林学智,等.个性化金属三维打印髋臼翼形接骨板结合腹直肌外侧切口入路治疗复杂髋臼骨折[J].中华外科杂志,2017,55(3):172-178.
[3]Bastian JD,Savic M,Cullmann JL,et al. Surgical exposures and options for instrumentation in acetabular fracture fixation:Pararectus approach versus the modified Stoppa[J].Injury-international Journal of the Care of the Injured,2016,47(3):695-701.
[4]周潘宇,汪洋,夏琰,等.三维记忆内固定系统与重建钛板治疗髋臼骨折合并髋臼关节后脱位的临床对比研究[J].医学研究杂志,2018,47(1):2502-2505.
[5]Boelch SP,Jordan MC,Meffert RH,et al.Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures:a retrospective clinical study[J]. International Orthopaedics,2016,41(9):1-7.
[6]冯立文,蔡贤华,黄卫兵,等.前路经寰枢关节锁定钛板螺钉内固定系统三维稳定性的实验研究[J].中国矫形外科杂志,2014,22(7):643-646.
[7]Hernefalk B,Eriksson N,Borg T,et al. Estimating pre-traumatic quality of life in patients with surgically treated acetabular fractures and pelvic ring injuries:Does timing matter[J]. Injury-international Journal of the Care of the Injured,2016,47(2):389-394.
[8]张群,李国庆,岳晨,等.股方肌蒂骨瓣移植与空心加压螺钉联合治疗对股骨颈骨折患者Harris评分的影响[J].西部医学,2016,28(8):1090-1092.
[9]孙永建,李伟成,白伟坚,等.数字化技术辅助下利用改良Stoppa联合髂窝入路治疗复杂髋臼骨折的临床研究[J].中国骨与关节杂志,2017,6(11):810-813.
[10] Bozzio AE,Johnson CR,Mauffrey C. Short-term results of percutaneous treatment of acetabular fractures:functional outcomes,radiographic assessment and complications[J]. International Orthopaedics,2016,40(8):1-6.
[11]熊绪,徐敏,邹鸿星,等.改良Stoppa联合Kocher-Langenbeck入路在复杂髋臼骨折手术治疗中的应用[J].中国骨与关节损伤杂志,2016,31(10):1062-1063.
[12]张彬,李涛,麦奇光,等.经腹直肌外侧入路钢板结合后柱拉力螺钉内固定治疗髋臼前后柱骨折[J].中国骨与关节损伤杂志,2017,32(4):337-340.
[13]黄焱星,徐利军.动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折临床疗效比较[J].西部医学,2016,28(8):1100-1103.
[14]曹俊培,沈谷丰,陆佳龙,等.漂浮体位Letournel和Kocher-Langenbeck联合入路治疗粉碎性髋臼骨折[J].中国综合临床,2015,37(2):1540-1542.
[15]曹烈虎,周启荣,翁蔚宗,等.前柱钢板联合后柱拉力螺钉固定复杂髋臼骨折的生物力学研究[J].第二军医大学学报,2017,38(11):1397-1402.
[16]梁云扬.三维记忆内固定与髋臼重建钛板系统修复髋臼后壁骨折伴关节后脱位的比较[J].中国组织工程研究,2015,19(22):3538-3542.
[17]包理忠,郑胜平,张文凯,等.重建钛板垂直交叉内固定治疗髋臼前柱及方形区骨折[J].中国骨与关节损伤杂志,2014,29(2):164-165.
[18]刘超,王武超,唐明杰,等.改良的Stoppa入路在髋臼后柱骨折手术中的效果[J].国际骨科学杂志,2017,38(4):271-272.
[19]刘曦明,黄进成,蔡贤华,等.前路钛板加方形区螺钉联合改良后柱拉力螺钉治疗涉及方形区的复杂髋臼骨折[J].中华创伤骨科杂志,2014,16(2):110-114.
[20]马俊.前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折40例分析[J].中国矫形外科杂志,2016,24(24):2297-2299.
[21]杨运平,曹生鲁,凌伟,等.Stoppa入路内髂坐钢板固定治疗累及后柱的复杂髋臼骨折[J].中华骨科杂志,2017,37(13):793-800.
[22]金天明,黄燕.髋关节置换手术与动力髋螺钉内固定治疗移位型股骨颈骨折的疗效比较[J].中国现代医学杂志,2017,27(23):112-116.
[23]马晓飞,涂杨茂.前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折临床观察[J].解放军医药杂志,2017,29(10):46-49.
[24]黄进成,刘曦明,蔡贤华,等.前路钛板加方形区螺钉联合后柱螺钉治疗髋臼双柱骨折的有限元分析[J].中国矫形外科杂志,2014,22(12):1104-1110.
[25]林冠林,陈庄洪,蔡贤华,等.前路特殊塑形钛板加方形区螺钉治疗伴有对侧骨盆前环不稳定波及双柱的髋臼骨折[J].创伤外科杂志,2016,18(4):200-203.
[2]麦奇光,谷诚,林学智,等.个性化金属三维打印髋臼翼形接骨板结合腹直肌外侧切口入路治疗复杂髋臼骨折[J].中华外科杂志,2017,55(3):172-178.
[3]Bastian JD,Savic M,Cullmann JL,et al. Surgical exposures and options for instrumentation in acetabular fracture fixation:Pararectus approach versus the modified Stoppa[J].Injury-international Journal of the Care of the Injured,2016,47(3):695-701.
[4]周潘宇,汪洋,夏琰,等.三维记忆内固定系统与重建钛板治疗髋臼骨折合并髋臼关节后脱位的临床对比研究[J].医学研究杂志,2018,47(1):2502-2505.
[5]Boelch SP,Jordan MC,Meffert RH,et al.Comparison of open reduction and internal fixation and primary total hip replacement for osteoporotic acetabular fractures:a retrospective clinical study[J]. International Orthopaedics,2016,41(9):1-7.
[6]冯立文,蔡贤华,黄卫兵,等.前路经寰枢关节锁定钛板螺钉内固定系统三维稳定性的实验研究[J].中国矫形外科杂志,2014,22(7):643-646.
[7]Hernefalk B,Eriksson N,Borg T,et al. Estimating pre-traumatic quality of life in patients with surgically treated acetabular fractures and pelvic ring injuries:Does timing matter[J]. Injury-international Journal of the Care of the Injured,2016,47(2):389-394.
[8]张群,李国庆,岳晨,等.股方肌蒂骨瓣移植与空心加压螺钉联合治疗对股骨颈骨折患者Harris评分的影响[J].西部医学,2016,28(8):1090-1092.
[9]孙永建,李伟成,白伟坚,等.数字化技术辅助下利用改良Stoppa联合髂窝入路治疗复杂髋臼骨折的临床研究[J].中国骨与关节杂志,2017,6(11):810-813.
[10] Bozzio AE,Johnson CR,Mauffrey C. Short-term results of percutaneous treatment of acetabular fractures:functional outcomes,radiographic assessment and complications[J]. International Orthopaedics,2016,40(8):1-6.
[11]熊绪,徐敏,邹鸿星,等.改良Stoppa联合Kocher-Langenbeck入路在复杂髋臼骨折手术治疗中的应用[J].中国骨与关节损伤杂志,2016,31(10):1062-1063.
[12]张彬,李涛,麦奇光,等.经腹直肌外侧入路钢板结合后柱拉力螺钉内固定治疗髋臼前后柱骨折[J].中国骨与关节损伤杂志,2017,32(4):337-340.
[13]黄焱星,徐利军.动力髋螺钉与股骨近端髓内钉治疗老年股骨近端骨折临床疗效比较[J].西部医学,2016,28(8):1100-1103.
[14]曹俊培,沈谷丰,陆佳龙,等.漂浮体位Letournel和Kocher-Langenbeck联合入路治疗粉碎性髋臼骨折[J].中国综合临床,2015,37(2):1540-1542.
[15]曹烈虎,周启荣,翁蔚宗,等.前柱钢板联合后柱拉力螺钉固定复杂髋臼骨折的生物力学研究[J].第二军医大学学报,2017,38(11):1397-1402.
[16]梁云扬.三维记忆内固定与髋臼重建钛板系统修复髋臼后壁骨折伴关节后脱位的比较[J].中国组织工程研究,2015,19(22):3538-3542.
[17]包理忠,郑胜平,张文凯,等.重建钛板垂直交叉内固定治疗髋臼前柱及方形区骨折[J].中国骨与关节损伤杂志,2014,29(2):164-165.
[18]刘超,王武超,唐明杰,等.改良的Stoppa入路在髋臼后柱骨折手术中的效果[J].国际骨科学杂志,2017,38(4):271-272.
[19]刘曦明,黄进成,蔡贤华,等.前路钛板加方形区螺钉联合改良后柱拉力螺钉治疗涉及方形区的复杂髋臼骨折[J].中华创伤骨科杂志,2014,16(2):110-114.
[20]马俊.前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折40例分析[J].中国矫形外科杂志,2016,24(24):2297-2299.
[21]杨运平,曹生鲁,凌伟,等.Stoppa入路内髂坐钢板固定治疗累及后柱的复杂髋臼骨折[J].中华骨科杂志,2017,37(13):793-800.
[22]金天明,黄燕.髋关节置换手术与动力髋螺钉内固定治疗移位型股骨颈骨折的疗效比较[J].中国现代医学杂志,2017,27(23):112-116.
[23]马晓飞,涂杨茂.前路钛板加方形区螺钉联合改良后柱螺钉治疗复杂髋臼骨折临床观察[J].解放军医药杂志,2017,29(10):46-49.
[24]黄进成,刘曦明,蔡贤华,等.前路钛板加方形区螺钉联合后柱螺钉治疗髋臼双柱骨折的有限元分析[J].中国矫形外科杂志,2014,22(12):1104-1110.
[25]林冠林,陈庄洪,蔡贤华,等.前路特殊塑形钛板加方形区螺钉治疗伴有对侧骨盆前环不稳定波及双柱的髋臼骨折[J].创伤外科杂志,2016,18(4):200-203.