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MIPPO技术与改良Stoppa入路治疗骨盆前环骨折的疗效对比
Comparison of effect of pelvic anterior ring fractures using the MIPPO approach versus the modified Stoppa approach
投稿时间:2022-02-23  修订日期:2022-05-20
DOI:10.3969/j.issn.1672-5972.2022.06.013
中文关键词:  骨盆前环骨折  MIPPO技术  改良Stoppa入路
英文关键词:Pelvic anterior ring fractures  MIPPO approach  Modified Stoppa approach
基金项目:
作者单位E-mail
李剑文 华中科技大学同济医学院附属同济医院骨科湖北 武汉430030 1280071148@qq.com 
张伟凯 华中科技大学同济医学院附属同济医院骨科湖北 武汉430030 weikai-zhang@qq.com 
朱美芃 华中科技大学同济医学院附属同济医院骨科湖北 武汉430030 1959593769@qq.com 
黄晖 华中科技大学同济医学院附属同济医院骨科湖北 武汉430030 hhjs201976135@163.com 
夏成焱* 华中科技大学同济医学院附属同济医院骨科湖北 武汉430030 332087058@qq.com 
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中文摘要:
      目的 比较MIPPO技术与改良Stoppa入路固定骨盆前环骨折的临床效果。方法 回顾性分析华中科技大学同济医学院附属同济医院2016年9月至2019年10月行手术治疗的34例骨盆前环骨折患者的临床资料,分为MIPPO技术组(20例)及改良Stoppa入路组(14例)。比较两组的手术时间、术中出血量、切口长度、ASA评分、术中透视次数、术后炎性指标(D-D二聚体定量、降钙素原、超敏C反应蛋白、血沉、白细胞计数、中性粒细胞计数)、术后住院时长、下地时间、骨折愈合时间、完全负重时间及并发症发生率,采用Matta评分及Majeed评分评估骨盆骨折术后恢复情况。结果 两组患者平均随访时间为(30.24±9.39)个月(20 ~ 60个月)。MIPPO技术组的手术时间、术中出血量、切口长度及术中透视次数均低于改良Stoppa入路组(P<0.05);术后MIPPO技术组炎性指标(D-D二聚体定量、血沉、中性粒细胞)、术后住院时长及下地时间低于或早于改良Stoppa入路组(P<0.05);两组之间ASA评分、降钙素原、超敏C反应蛋白、白细胞计数、骨折愈合时间、完全负重时间、Matta评分等级、Majeed评分及等级,以及并发症发生率差异比较,无统计学意义(P>0.05)。术后7 d内复查骨盆正位X线,MIPPO技术组及改良Stoppa入路组的Matta评分优良率分别为95.00%、85.71%。末次随访时,MIPPO技术组及改良Stoppa入路组的Majeed评分优良率分别为90.00%、78.57%。结论 MIPPO技术治疗骨盆前环骨折可获得满意效果,与改良Stoppa术式相比,具有手术时间短、术中出血量少、手术切口小及术后下地早等优势,值得推广。
英文摘要:
      Objective To compare the clinical outcomes of unstable pelvic anterior ring fractures using the MIPPO approach versus the modified Stoppa approach.Methods The clinical data of 34 patients with pelvic anterior ring fractures who were treated surgically in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from September 2016 to October 2019 was analyzed retrospectively, and they were classified into the MIPPO approach group (20 cases) and the modified Stoppa approach group (14 cases). The operation time, intraoperative blood loss, incision length, ASA score, intraoperative fluoroscopy frequencies, postoperative inflammatory indicators (D-D dimer, procalcitonin, hypersensitive C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), white blood cell count, and neutrophile granulocyte count), length of postoperative hospital stay, ambulation time, bone union time, full loading time, and complications rate were compared between the two groups. Matta score and Majeed score were used to evaluate recovery condition of pelvic fractures postoperatively.Results The average followed-up time was (30.24±9.39) months (20-60 months) in two groups. The operation time, intraoperative blood loss, incision length and intraoperative fluoroscopy frequencies in the MIPPO approach group were lower than those in the modified Stoppa approach group (P<0.05). Postoperatively, the inflammatory indicators (D-D dimer, ESR and neutrophile granulocyte count), length of postoperative hospital stay, and ambulation time in the MIPPO approach group were lower or earlier than those in the modified Stoppa approach group (P<0.05). The ASA score, procalcitonin, hs-CRP, white blood cell count, bone union time, full loading time, Matta score grade, Majeed score and grade, and complications rate between two groups were not statistical difference (P>0.05). Reexamined anteroposterior X-ray of the pelvis within 7 days postoperatively, the excellent-good rate of Matta score in the MIPPO approach group and the modified Stoppa approach group were 95.00% and 85.71% separately. At last follow-up, the excellent-good rate of Majeed score in the MIPPO approach group and the modified Stoppa approach group were 90.00% and 78.57% separately.Conclusion The MIPPO approach to treat anterior pelvic ring can obtain satisfactory outcomes, and compared with the modified Stoppa approach, has some advantages of shorter operation time, lower blood loss, shorter incision length and postoperatively earlier ambulation time, etc. This method deserves promoting.
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