改良Stoppa术治疗骨盆髋臼骨折围术期指标及术后血清应激指标观察

陈栋; 朱峰; 龚杰; 耿德春; 王德超

doi:10.7619/jcmp.20210383

改良Stoppa术治疗骨盆髋臼骨折围术期指标及术后血清应激指标观察

陈栋¹,
朱峰²,
龚杰¹,
耿德春²,
王德超^3, ,

1.
江苏省苏州市相城人民医院骨科, 江苏苏州, 215000
2.
苏州大学附属第一医院关节创伤外科, 江苏苏州, 215000
3.
漯河医学高等专科学校附属第二医院骨科, 河南漯河, 462300

基金项目:

河南省教育厅科学技术研究重点项目 16B320013

详细信息

通讯作者:
王德超, E-mail: ggp5hh@163.com

中图分类号: R683.3;R687.3
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出版历程
- 收稿日期: 2021-01-19
- 网络出版日期: 2021-04-29
- 发布日期: 2021-04-27

Observation on perioperative indexes and postoperative serum stress indexes of modified Stoppa surgery in treatment of pelvic and acetabular fracture

1.
Department of Orthopaedics, Suzhou City Xiangcheng People's Hospital, Suzhou, Jiangsu, 215000
2.
Department of Joint Trauma Surgery, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000
3.
Department of Orthopedics, Second Affiliated Hospital of Luohe Medical College, Luohe, Henan, 462300

摘要

摘要:
目的观察骨盆髋臼骨折患者采用改良Stoppa术治疗的围术期指标及术后血清应激指标情况。
方法选取70例骨盆髋臼骨折患者作为研究对象，将其随机分为改良组和常规组，每组35例。常规组进行常规髂腹股沟入路手术，改良组进行改良Stoppa入路手术，比较2组患者手术时间、术中出血量、切口长度、骨折愈合时间、住院时间以及术后视觉模拟评分法（VAS）评分，并比较2组手术前后血清皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（E）水平和骨折恢复后Majeed功能评分、术后并发症发生情况。
结果改良组手术时间、住院时间和切口长度短于常规组，术中出血量少于常规组，差异有统计学意义（P < 0.05）。改良组术后NE、E、Cor水平高于术前，但低于常规组，差异有统计学意义（P < 0.05）。改良组术后性功能、步态评分高于常规组，差异有统计学意义（P < 0.05）。改良组术后并发症总发生率为17.14%，低于常规组的40.00%，差异有统计学意义（P < 0.05）。
结论改良Stoppa术治疗骨盆髋臼骨折可缩短手术时间，减少手术出血量，加快患者术后恢复，减轻手术应激反应，且能减少术后并发症的发生。
- 改良Stoppa术 /
- 髂腹股沟入路 /
- 骨盆髋臼骨折 /
- 手术应激反应 /
- 出血量 /
- 并发症
Abstract:
Objective To observe perioperative indexes and postoperative serum stress indexes of modified Stoppa surgery in treatment of pelvic and acetabular fracture.
Methods A total of 70 patients with pelvic and acetabular fractures were selected and randomly divided into modified group and conventional group, with 35 cases in each group. The conventional group was operated through the conventional ilioinguinal approach, and the modified group was given modified Stoppa approach surgery. The operative time, intraoperative hemorrhage, incision length, hospital stay and postoperative Visual Analogue of Pain (VAS) were compared between the two groups. The levels of serum cortisol (Cor), norepinephrine (NE) and epinephrine (E) before and after operation were compared between the two groups. The Majeed function score and postoperative complications of the two groups were compared.
Results The operation time, incision length and hospital stay of the modified group were significantly shorter, and intraoperative blood loss was significantly less than those of the conventional group (P < 0.05). The NE, E and Cor levels after operation in the modified group were significantly higher than before operation, but were lower than those in the conventional group (P < 0.05). The scores of sexual function and gait in the modified group were significantly higher than those in the conventional group after operation (P < 0.05). The total incidence of postoperative complications in the modified group was 17.14%, which was significantly lower than 40.00% in the conventional group (P < 0.05).
Conclusion Modified Stoppa surgery can shorten operative time, reduce bleeding loss and postoperative complications, accelerate postoperative recovery, and relieve stress response.
- modified Stoppa surgery /
- ilioinguinal approach /
- pelvic acetabulum fracture /
- surgical stress reaction /
- bleeding volume /
- complication

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表 1 2组患者围术期指标比较(x±s)

组别	手术时间/min	术中出血量/mL	切口长度/cm	骨折愈合时间/月	住院时间/d	术后VAS评分/分
常规组(n=35)	203.41±19.84	197.54±24.15	16.24±2.14	3.20±0.58	15.63±2.36	7.69±0.94
改良组(n=35)	188.46±21.14^*	139.86±21.38^*	14.46±2.41^*	3.09±0.47	14.32±2.13^*	7.84±0.97
VAS: 视觉模拟评分法。与常规组比较, *P < 0.05。

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表 2 2组手术前后血清应激指标水平比较(x±s)

组别	NE/(mmol/L)		E/(mmol/L)		Cor/(μg/L)
组别	术前	术后	术前	术后	术前	术后
常规组(n=35)	0.85±0.15	1.10±0.24^*	0.35±0.07	0.84±0.12^*	149.78±14.32	261.54±22.47^*
改良组(n=35)	0.81±0.16	0.95±0.20^*#	0.33±0.06	0.58±0.07^*#	151.46±15.41	221.46±20.67^*#
NE: 去甲肾上腺素; E: 肾上腺素; Cor: 皮质醇。与术前比较, *P < 0.05; 与常规组比较, #P < 0.05。

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表 3 2组术后Majeed功能评分比较(x±s) 分

组别	疼痛	工作能力	坐立情况	性功能	辅助步行	步态	行走距离
常规组(n=35)	25.14±3.24	13.78±2.16	7.54±2.31	2.71±0.56	9.96±1.41	8.74±1.05	9.20±0.98
改良组(n=35)	24.38±3.12	14.61±2.84	7.14±1.36	3.04±0.61^*	10.41±1.23	9.88±1.13^*	9.61±1.08
与常规组比较, *P < 0.05。

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表 4 2组术后并发症发生情况比较[n(%)]

组别	切口感染	深静脉血栓	内固定失效	股外侧皮神经损伤	股内收肌肌力下降	合计
常规组(n=35)	3(8.57)	2(5.71)	3(8.57)	2(5.71)	4(11.43)	14(40.00)
改良组(n=35)	2(5.71)	0	1(2.86)	1(2.86)	2(5.71)	6(17.14)^*
与常规组比较, *P < 0.05。

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