李军 黄志雄

摘 要 目的：探讨经腹直肌旁入路和髂腹股沟入路治疗复杂骨盆髋臼骨折的临床疗效。方法：选取64例复杂骨盆髋臼骨折患者为研究对象，根据就诊顺序分为对照组和治疗组各32例。对照组行髂腹股沟入路，治疗组行腹直肌旁入路。随访6个月，比较两组患者的手术情况、髋关节功能恢复情况、复位满意度及并发症发生情况。结果：治疗组髋关节功能优良率显著高于对照组（93.75% vs 78.13%，P<0.05），治疗组手术时间、术中出血量、切口长度及住院时间均显著少于对照组（P<0.05），治疗组并发症发生率及复位满意率与对照组比较无统计学差异（P>0.05）。结论：经腹直肌旁入路手术切口小、术中出血量少，患者术后恢复快，在改善患者髋关节功能方面较髂腹股沟入路手术更具优势。

关键词 经腹直肌旁入路 髂腹股沟入路 复杂骨盆髋臼骨折 髋关节功能

中图分类号：R683.3 文献标志码：B 文章编号：1006-1533（2019）01-0041-03

Comparison of the efficacy of transrectus abdominis approach and ilioinguinal approach in the treatment of complex pelvic and acetabular fractures

LI Jun， HUANG Zhixiong

（the First Department of Orthopedics， Maoming Hospital of TCM， Guangdong Maoming 525000， China）

ABSTRACT Objective： To investigate the clinical effect of transrectus abdominis approach and ilioinguinal approach in the treatment of complex pelvic and acetabular fractures. Methods： Sixty-four patients with complex pelvic and acetabular fractures were selected as the study subjects. According to the order of their treatment， they were divided into a control group and a treatment group with 32 cases each. The control group underwent ilioinguinal approach while the treatment group underwent pararectus approach. The operation condition， hip function recovery， reduction satisfaction and complications were compared between the two groups after the patients were followed up for 6 months. Results： The excellent and good rate of hip function in the treatment group was significantly higher than that in the control group （93.75% vs 78.13%， P<0.05）. The operation time， intraoperative bleeding volume， incision length and hospitalization time in the treatment group were significantly less than those in the control group （P<0.05）. There were no significant differences in the incidence of complications and satisfaction rate of reduction between the two groups （P>0.05）. Conclusion： Pararectus abdominis approach has smaller incision， less bleeding and faster recovery and more advantages in the improvement of hip function compared with ilioinguinal approach.

KEy WORDS pararectus approach； illoinguinal approach； complex pelvic and acetabular fracture； hip-joint function

復杂骨盆髋臼骨折是指因突出盆骨的暴力或股骨头滑出髋臼所致的一种创伤性骨折，因髋臼位置深，解剖结构复杂，因此治疗难度较大。近年来，随着社会经济的快速发展及交通、工业事故的增加使得骨盆、髋臼骨折等高能量损伤的发生率逐年增长，不仅严重影响患者的活动能力及生活质量，严重者甚至会导致残疾或威胁到患者的生命安全[1]。对于复杂骨盆髋臼骨折，临床上主要通过手术的方法来恢复患者的关节功能，提高其生活质量。髋关节作为人体重要的负重关节，如何选择最佳的入路方式减轻患者关节疼痛、促进术后功能恢复、减少并发症一直是骨科医生研究的热点[2]。近年来，随着手术方法的不断优化，Stoppa入路、髂腹股沟入路及腹直肌旁入路等均被临床广泛应用于复杂骨盆髋臼骨折的治疗中，其临床疗效也已被临床认可。……