浮髋损伤的治疗策略  

Operative treatment of floating hip injuries

作　　者：王钢[1] 陈鸿奋[1] 陈滨[1] 赵辉[1] 王富明[1] 

机构地区：[1]南方医科大学南方医院创伤骨科,广州510515

出　　处：《中华骨科杂志》2013年第10期1024-1030,共7页Chinese Journal of Orthopaedics

摘　　要：目的探讨浮髋损伤的发生机制、治疗策略、手术疗效及并发症治疗。方法回顾性分析2001年6月至2011年6月收治的33例浮髋损伤患者资料，男25例，女8例；年龄4-73岁，平均34．6岁；车祸伤20例，高处坠落伤11例，重物砸伤1例，平地摔伤1例。根据Liebergall分型方法，I型7例，Ⅱ型9例，Ⅲ型17例。患者均有合并伤，损伤严重度评分为16-55分，平均28．9分。32例股骨骨折行手术治疗，其中采用钢板或髓内钉固定29例，外固定架固定1例，行全髋关节置换2例；髋臼骨折采用重建钢板固定16例；骨盆骨折采用钢板、拉力螺钉或外固定架固定13例。结果28例（84．8％，28／33）患者获得随访，随访时间为2．3-10．1年，平均3．5年。其中I型和Ⅱ型共13例获得随访，根据Majeed评价标准评价髋关节功能，优8例，良3例，可2例，优良率84．6％（11／13）；m型15例获得随访，根据D’Aubign6和Postel标准评价髋关节功能：优7例，良4例，可3例，差1例，优良率73．3％（11／15）。伤侧膝关节功能按马元璋等评定标准：优23例，良3例，可1例，差1例，优良率92．9％（26／28）。并发症包括：创伤性关节炎（1例），坐骨神经损伤（2例），异位骨化（2例），股骨头坏死（1例），股骨骨不连（2例）。结论浮髋损伤属于复杂性损伤，常由高能量损伤引起，在抢救生命的基础上，对股骨骨折优先进行固定，而后再行髋臼及骨盆骨折治疗。创伤性关节炎、坐骨神经损伤、异位骨化、股骨头坏死、股骨骨不连是浮髋损伤较常见的并发症。Objective To discuss the mechanism of injury, treatment decisions, complications and surgical results of the floating hip injuries （FHI）. Methods Thirty-three patients with FHI were retrospectively analyzed in our hospital from June 2001 to June 2011. There were 25 males and 8 females, with an average age of 34.6 years （range, 4-73 years）. The mechanism of in- jury was motor vehicle collision for 20 patients, fall down from a height for 11, crushed injury for 1, and sports-related injury for 1. According to Liebergall classification for the floating hip injuries, there were 7 cases for type I （21.2%）, 9 for type II （27.2%） and 17 for type Ill （51.6%）. All patients had associated injuries, the average injury severity score （ISS） was 28.9. Thirty-two of the femoral fractures underwent surgical stabilization of their femoral fractures. Surgical stabilization methods included ORIF or in- tramedullary nailing （29 cases）, external fixation （1 case）, total hip arthroplasty （2 cases）. Acetabular fractures were treated with open reduction and internal fixation （ORIF） in 16 cases. Thirteen patients suffered pelvic fractures underwent surgical stabiliza- tion for at least one component of ring disruption. Results Twenty-eight cases （84.8%） were followed up for 2.3 to 10.1 years （average, 3.5 years）. Thirteen patients were followed up in the 16 patients who suffered type I or II fractures. According to Majeed functional evaluation, the results were excellent in 8 cases, good in 3 and fair in 2, with the excellent and good rate being 84.6%. Fifteen patients with type Ill were followed up, according to D＇Auhign6 and Postel evaluation criterion. The joint functions were excellent in 7 cases, good in 4, fair in 3, and poor in 1, with the excellent and good rate being 73.3%. According to Ma Yuanzhang functional evaluation, the knee functions of the all patients were excellent in 23 cases, good in 3, and fair in 2, with the excellent and good rate being 92.9%. Complications seen in

关 键 词：髋臼 骨折 股骨骨折 骨盆 

分 类 号：R687.3[医药卫生—骨科学]