经改良Hueter入路治疗PipkinⅠ型及Ⅱ型骨折的疗效观察  

Modified Hueter direct anterior approach for treatment of Pipkin type Ⅰ and Ⅱ femoral head fractures

作　　者：李沁[1,2] 黄富国[1] 项舟[1] 方跃[1] 钟刚[1] 易敏[1] 赵小丹[1] 刘雷[1] LI Qin;HUANG Fuguo;XIANG Zhou;FANG Yue;ZHONG Gang;YI Min;ZHAO Xiaodan;LIU Lei(Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;Department of Orthopaedics, Tibetan Chengdu Office Branch Hospital of West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041 [2]四川大学华西医院西藏成办分院骨科,成都610041

出　　处：《中国修复重建外科杂志》2018年第3期334-337,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用改良Hueter入路治疗PipkinⅠ、Ⅱ型骨折的疗效。方法 2014年9月—2016年5月采用改良Hueter入路治疗PipkinⅠ、Ⅱ型骨折12例。其中男8例,女4例;年龄32~60岁,平均40.2岁。致伤原因:交通事故伤9例,高处坠落伤3例。骨折按照Pipkin分型:Ⅰ型8例,Ⅱ型4例。受伤至入院时间2~28 h,平均7.2 h;入院后急诊(<6 h)行髋关节复位,复位成功后3~7 d,平均4.3 d进行手术,采用改良Hueter入路,从髋关节前方暴露股骨头骨折并予以Herbert螺钉加压固定。记录手术时间、术中出血量;末次随访时按照Thompson-Epstein评分法评定疗效。结果手术时间80~130 min,平均97.5 min;术中出血量100~200 mL,平均130.2 mL。术中复位及固定顺利,骨折达到解剖复位。12例患者均获随访,随访时间12~32个月,平均24.3个月。术后骨折均愈合,愈合时间15~20周,平均16.3周。无切口感染、股外侧皮神经损伤、股骨头缺血性坏死、异位骨化等并发症发生。3例患者发生创伤性骨关节炎。末次随访时按照Thompson-Epstein评分法评定疗效:优5例,良5例,可2例,优良率83.3%。结论应用改良Hueter入路治疗PipkinⅠ、Ⅱ型骨折,可充分暴露并固定股骨头骨折,具有解剖层次清晰、创伤小、手术时间短的优点。Objective To discuss the effectiveness of the modified Hueter direct anterior approach in treatment of Pipkin typeⅠ and Ⅱ femoral head fractures. Methods Between September 2014 and May 2016, 12 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures were treated with the modified Hueter direct anterior approach. There were8 males and 4 females, aged from 32 to 60 years（mean, 40.2 years）. The disease causes included traffic accident injury in 9 cases and falling from height injury in 3 cases. According to Pipkin typing, 8 cases were rated as type Ⅰ and 4 cases as type Ⅱ. The interval of injury and admission was 2-28 hours（mean, 7.2 hours）. Reduction was performed in all patients within 6 hours after admission, and then bone traction was given. The operation was performed in 3-7 days（mean,4.3 days） after redution. The modified Hueter direct anterior approach was applied to expose and fix femoral head fractures by Herbert screws compressively. The operation time and intraoperative blood loss were recorded, and the effectiveness was evaluated according to the Thompson-Epstein scale at last follow-up. Results The operation time was80-130 minutes（mean, 97.5 minutes）, and the intraoperative blood loss was 100-200 mL（mean, 130.2 mL）. All fractures achieved anatomical reduction and successful fixation. All 12 patients were followed up 12-32 months（mean,24.3 months）. All patients achieved bone union in 15-20 weeks（mean, 16.3 weeks） and no wound infection, lateral femoral cutaneous nerve injury, osteonecrosis of the femoral head, or heterotopic ossification occurred. Traumatic arthritis occured in 3 patients. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 5 cases, good in 5 cases, fair in 2 cases, and the excellent and good rate was 83.3%. Conclusion The modified Hueter direct anterior approach has the advantages of clear anatomic structure, less trauma, and shorter operation time, and it can effectively expose and fix the Pipkin typeⅠ and

关 键 词：股骨头骨折 髋关节后脱位 改良Hueter入路 

分 类 号：R687.3[医药卫生—骨科学]