摘要
目的 探讨髋关节外科脱位入路在股骨头骨折治疗中的应用效果。方法 回顾分析2010年1月-2013年2月采用髋关节外科脱位入路治疗的15例股骨头骨折患者临床资料,其中男11例,女4例;年龄15-63岁,平均30.8岁。致伤原因：交通事故伤9例,高处坠落伤5例,运动伤1例。按Pipkin分型：Ⅰ型2例,Ⅱ型7例,Ⅲ型1例,Ⅳ型5例。受伤至手术时间2-10 d,平均4.1 d。除5例入院前于外院复位,余10例均在伤后6 h内复位并行骨牵引,术后持续牵引4-6周。结果 术后伤口均Ⅰ期愈合,无脱位和下肢深静血栓形成等早期并发症。15例均获随访,随访时间25-36个月,平均29.9个月。无感染、内固定物断裂、股骨大转子骨折不愈合等并发症发生。随访期间3例出现股骨头坏死,其中2例无症状,MRI检查明确为国际骨循环协会（ARCO）分期Ⅱa和Ⅱb期;1例股骨头坏死至Ⅲb期且股骨颈骨折不愈合,行人工全髋关节置换术。4例发生骨化性肌炎,按Brooker分级为Ⅰ级2例、Ⅱ级1例、Ⅲ级1例,除1例行人工全髋关节置换术时清理,余未手术治疗。末次随访时按照Thompson-Epstein评价系统评价关节功能,获优9例,良3例,可1例,差2例,优良率80%。结论 髋关节外科脱位入路既能保护股骨头残存血管又能充分显露髋臼和股骨头,是治疗股骨头骨折的理想入路。
Objective To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture. Methods A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years（range, 15-63 years）. The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days（mean, 4.1 days）. Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital. Results Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months（range, 25-36 months）. During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous（ARCO） staging system], and 1（stage IIIb） had nonunion of the femoral neck fracture, who underwent total hip arthroplasty（THA）. In 4 patients having myositis ossificans（2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading）, no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%. Conclusion Surgical hip dislocation approach can not only protect the residual vessels o
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第11期1327-1331,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
股骨头骨折
髋关节脱位
手术入路
Femoral head fracture
Hip dislocation
Operative approach
