Pipkin骨折中髋臼盂唇损伤的诊断及治疗  

DIAGNOSIS AND TREATMENT OF ACETABULAR LABRUM INJURY IN PIPKIN FRACTURE

作　　者：陈志伟[1] 梁先勇[1] 伍俊星 崔俊成[1] 唐志斌[1] 范伟杰[1] 李春[1] 吴文特[1] 戴祝[1] 

机构地区：[1]南华大学附属第一医院骨科,湖南衡阳421001

出　　处：《中国修复重建外科杂志》2015年第1期14-18,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的总结Pipkin骨折中髋臼盂唇损伤的特点及采用带线锚钉修复的临床疗效。方法 2010年7月—2013年7月,收治Pipkin骨折合并髋臼盂唇损伤患者10例。其中男7例,女3例;年龄24-56岁,平均32.5岁。致伤原因：交通事故伤8例,高处坠落伤2例。根据Pipkin骨折分型：Ⅱ型6例,Ⅲ型2例,Ⅳ型2例。受伤至手术时间为6-14 d,平均8 d10采用经转子入路大转子截骨治疗Pipkin骨折、带线锚钉修复髋臼盂唇。术后参照Thompson及Epstein临床和影像学评定标准评价其临床疗效。结果术后切口均Ⅰ期愈合,无深部感染、下肢深静脉血栓形成等早期并发症发生。10例患者均获随访,随访时间12-48个月,平均22个月。X线片复查示大转子截骨、髋臼骨折愈合时间为3-4个月,股骨颈、股骨头骨折愈合时间为6-11个月。MRI复查示髋臼盂唇均愈合良好。1例患者术后12个月出现股骨头缺血性坏死,行人工全髋关节置换术。末次随访时,按Thompson及Epstein临床和影像学评定标准,获优5例,良3例,中1例,差1例,优良率80%。结论 Pipkin骨折中髋臼盂唇损伤易漏诊,术前需结合髋关节MRI辅助诊断。采用经转子入路大转子截骨治疗Pipkin骨折、带线锚钉修复髋臼盂唇,能有效恢复髋关节功能,疗效满意。Objective To observe the characteristics of acetabular labrum injury in Pipkin fractures and the effectiveness of repairing the labrum with suture anchor. Methods Between July 2010 and July 2013,10 cases of Pipkin fractures accompanied by acetabular labrum injury were treated. There were 7 males and 3 females with an average age of 32.5 years（range,24-56 years）. The causes of injury included traffic accident in 8 cases and falling from height in 2 cases. According to the Pipkin classification criteria,there were 6 cases of type II,2 cases of type III,and 2 cases of type IV. The average interval from injury to operation was 8 days（range,6-14 days）. All the patients underwent open reduction and internal fixation through transtrochanteric approach with trochanteric osteotomy,and repair the labrum with suture anchor. The effectiveness was evaluated according to the Thompson Epstein scoring scales after operation. Results All incisions healed primarily without early complication of deep infection or deep vein thrombosis of lower limb. All the cases were followed up 22 months on average（range,12-48 months）. X-ray films showed that all osteotomies and acetabular fractures healed within 3-4 months,femoral head and femoral neck fracture healed within 6-11 months. MRI examinations showed that all repaired acetabular labrums well healed. One case had necrosis of the femoral head at 12 months after operation,and was treated by total hip arthroplasty. According to the Thompson Epstein scoring scales at last follow-up,the results were excellent in 5 cases,good in 3 cases,fair in 1 case and poor in 1 case,with an excellent and good rate of 80%. Conclusion The diagnosis of acetabular labrum injury can be easily missed during Pipkin fracture,preoperative diagnosis should be combined with hip MRI. Trochanteric osteotomy through transtrochanteric approach,and repairing the labrum with suture anchor can restore the hip function effectively.

关 键 词：PIPKIN骨折 髋臼盂唇损伤 大转子截骨 带线锚钉 

分 类 号：R687.3[医药卫生—骨科学]