髋内侧入路治疗PipkinⅠ、Ⅱ型股骨头骨折  

The treatment of femoral head fractures （Pipkin type Ⅰ and Ⅱ ） via medial hip approach

作　　者：刘兆杰[1] 金鑫[1] 孙玉玺 戚浩天 田维[1] 李刚[1] 贾健[1] 

机构地区：[1]天津医院骨盆科,300211

出　　处：《中华骨科杂志》2018年第5期257-263,共7页Chinese Journal of Orthopaedics

摘　　要：目的 探讨髋内侧入路治疗PipkinⅠ、Ⅱ型股骨头骨折的临床疗效。方法 回顾性分析2014年10月至2015年8月应用髋内侧入路治疗并获得随访的16例PipkinⅠ、Ⅱ型股骨头骨折患者资料,男13例,女3例;年龄22~62岁,平均44.8岁;PipkinⅠ型12例,Ⅱ型4例,均合并髋关节后脱位;车祸伤13例,坠落伤2例,砸伤1例;受伤至手术时间2~14 d,平均5.3 d。16例患者髋关节后脱位均在闭合复位后行患肢骨牵引,术前常规行髋关节三维CT扫描;手术均采用髋内侧入路切开,复位后置入可吸收钉进行固定。结果 手术时间60~110 min,平均75 min;手术切口长约6~9 cm,平均7.1 cm;术中出血80~300 ml,平均160 ml。术后16例患者均获得随访,随访时间24~30个月,平均26.3个月。其中8例PipkinⅠ型及3例PipkinⅡ型骨折愈合时间为3~12个月,平均8.8个月;3例PipkinⅠ型术后24个月随访时为骨折部分愈合;1例PipkinⅠ型及1例PipkinⅡ型骨折术后24个月随访时仍可见骨折线存在。末次随访时,Thompson和Epstein评价,优12例,良1例,可3例,优良率81.3% （13/16）;Merle d’ Aubigne和Postel评分为10~18分,平均15.75分,优13例,良1例,可2例,优良率87.5%（14/16）。所有患者术中均未出现神经、血管损伤,术后无一例发生伤口感染、脂肪液化等切口相关并发症及异位骨化。术后1例患者出现股骨头坏死,经减少活动对症治疗后未见明显加重;2例发生骨折不愈合,但患者功能满意日常生活不受影响;2例合并创伤性关节炎,予非甾体药物治疗后减轻;3例出现骨折块吸收,但患者功能满意未进一步治疗。结论 髋内侧入路治疗PipkinⅠ、Ⅱ型股骨头骨折可获得良好显露,有利于复位和固定,手术创伤小,治疗效果满意。Objective To investigate the clinical Results and summarize the advantages and surgical indications in the treatment of femoral head fractures （Pipkin type I and II） via medial hip approach. Methods From October 2014 to August 2015, sixteen patients of femoral head fracture （Pipkin type Ⅰ and Ⅱ） surgically treated via medial hip approach were retrospectively analyzed in our Hospital. There were 13 males and 3 females with an average age of 44.8 years （range, 22-62 years old）. According to Pipkin classification, 12 femoral head fractures were classified as type I and 4 type II. Thirteen patients were injured by traffic accidents, two patients by falling down from height and one patient was injured by collapses of a heavy Objective . All femoral head fractures were combined with posterior hip dislocation. The skeletal traction was performed in each patient after successful close reduction of the hip joint under general anesthesia. Computed Tomography scans of hip joints were performed routinely. All femoral head fractures were fixed with absorbable screws via medial hip approach. The mean time from injury to operation was 5.3 days （range, 2-14 days）. Results The average duration of the operations was 75 min （range, 60-110 min）. The average length of incisions was 7.1 cm （range, 6-9 cm）. The average blood loss was 160 ml （range, 80-300 ml）. All the patients were followed up for an average period of 26.3 months （range, 24 to 30 months）. Eight femoral head fractures with Pipkin I and three with Pipkin II were union and the healing time was 3-12 months, with an average time of 8.8 months. Three femoral head fractures with Pipkin I were incomplete union at the latest follow-up of 24 months after surgery. One femoral head fracture with Pipkin Ⅰ and one with Pipkin II didn’t get union at the latest follow-up of 24 months after surgery. According to Thompson and Epstein function evaluation, the clinical outcomes were rated as excellent in 12 cases, good in 1, fair in 3. The excellen

关 键 词：外科手术 微创性 股骨头 骨折 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]