| 张新,许玉林,李雨果,等.经腹直肌外侧入路联合3D打印技术治疗老年复杂髋臼骨折的临床疗效评价.骨科,2023,14(3): 238-244. |
| 经腹直肌外侧入路联合3D打印技术治疗老年复杂髋臼骨折的临床疗效评价 |
| Clinical Efficacy of Lateral-rectus Approach Combined with 3D Printing Technology in Treating Elderly Complex Acetabular Fractures |
| 投稿时间：2022-06-23 |
| DOI：10.3969/j.issn.1674-8573.2023.03.008 |
| 中文关键词: 腹直肌外侧入路 3D打印 老年 复杂 髋臼骨折 疗效 |
| 英文关键词: Lateral-rectus approach 3D printing Elderly Complex Acetabular fractures Efficacy |
| 基金项目:泸州市政府与西南医科大学科技战略合作课题（2020LZXNYDJ-06） |
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| 中文摘要: |
| 目的 对经腹直肌外侧入路联合3D打印技术治疗老年复杂髋臼骨折的临床疗效进行评价。方法 回顾性分析2018年1月至2019年12月于我院行外科手术治疗的74例复杂髋臼骨折老年病人的临床资料，按照治疗方式的不同分为研究组与对照组，研究组38例，对照组36例。对照组采用传统经髂腹股沟入路联合3D打印技术，研究组采用经腹直肌外侧入路联合3D打印技术治疗。记录两组病人切口长度、骨折部位暴露时间、术中出血量、手术时间及术后骨折复位质量情况。比较两组病人术前、术后3个月及6个月时的髋关节改良Merle D'Aubigne-Postel评分变化；分析术前及术后6个月时，两组病人髋关节活动状态（伸展、前屈、内收、外展）变化；比较两组病人在术后1个月内的并发症发生情况差异；术后1周采用Matta影像学评估标准比较两组术后骨折复位质量差异。结果 研究组病人手术切口长度、骨折部位暴露时间、手术用时均短于对照组（P＜0.05），且术中出血量少于对照组（P＜0.05）；术后3个月及6个月，两组病人改良Merle D'Aubigne-Postel评分均较术前升高（P＜0.05），且研究组均高于同一时间对照组（P＜0.05）；术后6个月时，两组病人伸展、前屈、内收、外展度数均较术前增大（P＜0.05），且研究组大于同一时间对照组（P＜0.05）；术后1个月内，两组病人深静脉血栓、切口感染、腹疝以及神经损伤发生率比较，差异无统计学意义（P＞0.05）；术后1周研究组骨折复位总体优良率高于对照组（P＜0.05）。结论 经腹直肌外侧入路联合3D打印技术能够减轻行复杂髋臼骨折手术的老年病人手术创伤并缩短手术时间，有助于改善其术后髋关节功能与活动状态，有效提高老年复杂髋臼骨折复位质量。 |
| 英文摘要: |
| Objective To evaluate the clinical efficacy of the lateral-rectus approach combined with 3D printing technology in the treatment of elderly complex acetabular fractures. Methods A retrospective analysis was performed on the clinical data of 74 elderly patients with complex acetabular fractures who underwent surgical treatment from January 2018 to December 2019, and the patients were divided into study group and control group, with 38 cases in the study group and 36 cases in the control group. Control group was given traditional ilioinguinal approach with 3D printing technology, and study group was treated with the lateral-rectus approach combined with 3D printing technology. The differences in surgical status (incision length, fracture site exposure time, intraoperative blood loss, surgical time) and quality of fracture reduction were recorded in the two groups. The changes of hip joint function (modified Merle D'Aubigne-Postel scoring system) were compared between the two groups before and 3, 6 months after surgery. The changes in hip joint activities (extension, anteflexion, adduction, abduction) were analyzed in the two groups before and 6 months after surgery. The occurrence of postoperative complications was compared between the two groups within 1 month after surgery. At one week after the operation, the Matta imaging evaluation standard was used to compare the difference in the quality of postoperative fracture reduction between the two groups. Results The surgical incision length, exposure time of fracture site and surgical time in the study group were shorter than those in the control group (P＜0.05), and the intraoperative blood loss was less than that in control group (P＜0.05). At 3 and 6 months after surgery, the scores of modified Merle D'Aubigne-Postel scoring system in the two groups were higher than those before surgery (P＜0.05), and those in the study group were higher than those in the control group at the same time points (P＜0.05). At 6 months after surgery, the degrees of extension, anteflexion, adduction and abduction in the two groups were increased as compared with those before surgery (P＜0.05), and those in the study group were greater than those in the control group at the same time points (P＜0.05). Within 1 month after surgery, there were no statistically significant differences in the incidence rates of deep vein thrombosis, incision infection， nerve injury and abdominal hernia between the two groups (P＞0.05). At 1 week after operation, the overall excellent and good rate of fracture reduction in the study group was higher than that in the control group (P＜0.05). Conclusion The lateral-rectus approach combined with 3D printing technology can relieve the surgical trauma and shorten the surgical time of elderly patients undergoing complex acetabular fracture surgery, help improve the postoperative hip joint function and activities. |
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