中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
5期
376-380
,共5页
杨永良%周东生%李连欣%辛茂源%王国栋
楊永良%週東生%李連訢%辛茂源%王國棟
양영량%주동생%리련흔%신무원%왕국동
髋臼%骨折%主动脉,腹%阻断疗法%出血
髖臼%骨摺%主動脈,腹%阻斷療法%齣血
관구%골절%주동맥,복%조단요법%출혈
Acetabulum%Fractures,bone%Aorta,abdominal%Withholding treatment%Hemorrhage
目的 探讨暂时性腹主动脉球囊阻断术在陈旧性髋臼骨折切开复位内固定手术中的应用价值. 方法 2000年6月至2011年6月采用前后联合入路切开复位内固定治疗44例陈旧性髋臼骨折患者,2006年以后收治的23例患者中17例接受暂时性腹主动脉球囊阻断术以控制术中出血(阻断组),男10例,女7例；平均年龄为(33.5±1.8)岁.骨折AO分型:B1型3例,B2型4例,B3型2例,C型8例.以2006年以前收治且未接受暂时性腹主动脉球囊阻断术的21例患者作为对照组,男12例,女9例；平均年龄为(31.2±2.4)岁.骨折AO分型:B1型5例,B2型7例,B3型3例,C型6例.记录并比较两组患者平均手术时间、出血量、输血量、复位优良率及术后功能优良率 结果 阻断组患者腹主动脉阻断时间平均为(48.5±18.9). min.阻断组和对照组患者平均手术时间、术中出血量及术中输血量比较差异均有统计学意义(P＜0 05).术后复位优良率根据改良的Matta复位标准评定:阻断组为82.4％ (14/17),对照组为81.0％(17/21),两组比较差异无统计学意义(P=0.323). 35例患者术后获12 ～30个月(平均18.4个月)随访.末次随方时根据改良Merle d'Aubigné和Postel评分标准评定患髋功能:阻断组优9例,良4例,可2例,差1例,优良率为81.3％；对照组优10例,良4例,可3例,差2例,优良率为73.7％,两组比较差异无统计学意义(P=0.277). 结论 陈旧性髋臼骨折术中应用暂时性腹主动脉球囊阻断术能更有效地控制术中出血、缩短手术时间,是一项有效的止血措施.
目的 探討暫時性腹主動脈毬囊阻斷術在陳舊性髖臼骨摺切開複位內固定手術中的應用價值. 方法 2000年6月至2011年6月採用前後聯閤入路切開複位內固定治療44例陳舊性髖臼骨摺患者,2006年以後收治的23例患者中17例接受暫時性腹主動脈毬囊阻斷術以控製術中齣血(阻斷組),男10例,女7例；平均年齡為(33.5±1.8)歲.骨摺AO分型:B1型3例,B2型4例,B3型2例,C型8例.以2006年以前收治且未接受暫時性腹主動脈毬囊阻斷術的21例患者作為對照組,男12例,女9例；平均年齡為(31.2±2.4)歲.骨摺AO分型:B1型5例,B2型7例,B3型3例,C型6例.記錄併比較兩組患者平均手術時間、齣血量、輸血量、複位優良率及術後功能優良率 結果 阻斷組患者腹主動脈阻斷時間平均為(48.5±18.9). min.阻斷組和對照組患者平均手術時間、術中齣血量及術中輸血量比較差異均有統計學意義(P＜0 05).術後複位優良率根據改良的Matta複位標準評定:阻斷組為82.4％ (14/17),對照組為81.0％(17/21),兩組比較差異無統計學意義(P=0.323). 35例患者術後穫12 ～30箇月(平均18.4箇月)隨訪.末次隨方時根據改良Merle d'Aubigné和Postel評分標準評定患髖功能:阻斷組優9例,良4例,可2例,差1例,優良率為81.3％；對照組優10例,良4例,可3例,差2例,優良率為73.7％,兩組比較差異無統計學意義(P=0.277). 結論 陳舊性髖臼骨摺術中應用暫時性腹主動脈毬囊阻斷術能更有效地控製術中齣血、縮短手術時間,是一項有效的止血措施.
목적 탐토잠시성복주동맥구낭조단술재진구성관구골절절개복위내고정수술중적응용개치. 방법 2000년6월지2011년6월채용전후연합입로절개복위내고정치료44례진구성관구골절환자,2006년이후수치적23례환자중17례접수잠시성복주동맥구낭조단술이공제술중출혈(조단조),남10례,녀7례；평균년령위(33.5±1.8)세.골절AO분형:B1형3례,B2형4례,B3형2례,C형8례.이2006년이전수치차미접수잠시성복주동맥구낭조단술적21례환자작위대조조,남12례,녀9례；평균년령위(31.2±2.4)세.골절AO분형:B1형5례,B2형7례,B3형3례,C형6례.기록병비교량조환자평균수술시간、출혈량、수혈량、복위우량솔급술후공능우량솔 결과 조단조환자복주동맥조단시간평균위(48.5±18.9). min.조단조화대조조환자평균수술시간、술중출혈량급술중수혈량비교차이균유통계학의의(P＜0 05).술후복위우량솔근거개량적Matta복위표준평정:조단조위82.4％ (14/17),대조조위81.0％(17/21),량조비교차이무통계학의의(P=0.323). 35례환자술후획12 ～30개월(평균18.4개월)수방.말차수방시근거개량Merle d'Aubigné화Postel평분표준평정환관공능:조단조우9례,량4례,가2례,차1례,우량솔위81.3％；대조조우10례,량4례,가3례,차2례,우량솔위73.7％,량조비교차이무통계학의의(P=0.277). 결론 진구성관구골절술중응용잠시성복주동맥구낭조단술능경유효지공제술중출혈、축단수술시간,시일항유효적지혈조시.
Objective To explore the efficacy of temporary balloon occlusion of the abdominal aorta during open reduction and internal fixation of delayed acetabular fractures. Methods From June 2000 to June 2011,44 patients with delayed acetabular fractures were surgically treated through combined approaches (ilio-inguinal approach and Kocher-Langenbeck approach) in our hospital.Seventeen patients who underwent temporary balloon occlusion of the abdominal aorta after 2006 were assigned into group A.They are 10 males and 7 females,with an average age of 33.5 ± 1.8 years.According to AO classification,3 cases were of type B1,4 cases of type B2,2 cases of type B3 and 8 cases of type C.The other 21 patients before 2006 were in the control group (group B).They were 12 males and 9 females,with an average age of 31.2 ±2.4 years.According to AO classification,5 cases were of type B1,7 cases of type B2,3 cases of type B3 and 6 cases of type C.Average operation time,intra-operative blood loss,blood transfusion,satisfactory reduction rate and functional recovery were recorded and compared between the 2 groups. Results The average time of blood flow occlusion was 48.5 ± 18.9 minutes in group A.In terms of operation time,intra-operative blood loss and blood transfusion,group A was significantly better than group B (P ＜ 0.05).By Matta evaluation system,the satisfactory reduction rate was 82.4％ in group A and 81.0％ in group B,with no significant differenee (P=0.323).Thirty-five patients were followed up from 12 to 30 months,with an average time of 18.4 months.By tbe Merle d'Aubigné and Postel evaluation system at the last follow-up,the good to excellent rates of functional recovery were 81.3％ in group A and 73.7％ in group B,with no significant difference ( P =0.277). Conclusion In treatment of delayed acetabular fractures,temporary balloon occlusion of the abdominal aorta is a reliable technique to control bleeding because it can reduce the intra-operative blood loss and shorten operation time.
