髋关节前外侧入路治疗Pipkin Ⅰ型和Ⅱ型骨折  

Treatment of Pipkin Ⅰ and Ⅱ hip fractures by anterolateral hip approach

作　　者：韩建华[1] 王海峰[1] 陈方虎[1] 陈刚[1] HAN Jian-hua;WANG Hai-feng;CHEN Fanghu;CHEN Gang(Department of Trauma and Joint Surgery,Taizhou Municipal Hospital,Taizhou 318000,Zhejiang,China)

机构地区：[1]台州市立医院创伤和关节外科,浙江台州318000

出　　处：《中国骨伤》2018年第9期858-862,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的 :探讨髋关节前外侧入路(Mc Farland及Osborne入路)可吸收螺钉内固定治疗PipkinⅠ、Ⅱ型骨折临床疗效。方法:回顾性分析2008年3月至2016年2月采用髋关节前外侧入路(Mc Farland及Osborne入路)可吸收螺钉固定治疗8例股骨头骨折患者,其中男5例,女3例;年龄23~58岁,平均36岁。入院时主要症状:髋关节疼痛、畸形、功能障碍。受伤至手术时间3~12 d,平均5 d。X线片及CT片示髋关节后脱位伴股骨头骨折。Pipkin骨折分型:Ⅰ型2例,Ⅱ型6例。所有患者急诊在静脉复合麻醉下行髋关节后脱位手法整复复位(Allis法),复位成功后给予骨牵引。术后采用Thompson-Epstein评价标准对髋关节功能进行评价。结果:所有患者术后手术切口Ⅰ期愈合,无其他并发症发生。8例患者获得随访,时间12~36个月,平均30个月。术后6个月复查X线及CT提示骨折愈合,愈合时间3~6个月,平均4个月。根据Thompson-Epstein评价标准:优5例,良2例,可1例。结论 :髋关节前外侧入路既能够不破坏股骨头残存血供、又能够充分显露髋臼和股骨头,是治疗PipkinⅠ、Ⅱ型骨折较理想的手术入路选择。Objective： To investigate the clinical effect of absorbable screw fixation by anterolateral approach （McFarland and Osborne approach） for the treatment of Pipkin typeⅠand typeⅡfractures.Methods： From March 2008 to February 2016,8 cases of femoral head fractures were treated by absorbable screw fixation through anterolateral approach （McFarland and Osborne approach） including 5 males and 3 females with an average age of 36 years old ranging 23 to 58 years old. The course of the disease was 3 to 12 days （means 5 days）. The symptoms at admission included hip pain,deformity and dysfunction. The X-ray and CT image showed femoral head fracture and posterior femoral dislocation. There were 2 cases of Pipkin type Ⅰand 6 cases of Pipkin typeⅡ. All patients received emergency reduction （Allis） of the posterior dislocation of the hip under the combined intravenous anesthesia. Bone traction was performed after successful reduction. The operation through McFarland and Osborne approach,the Thompson-Epstein system used to evaluate the curative effect postoperative.Results： All the patients had primary healing after operation without other complications occurred. The 8 patients were followed up for 12 to 36 months with an average of 30 months. All of the patients review of X-ray and CT 6 months postoperative showed fractures consolidated,and the healing time was 3 to 6 months with an average of 4 months. According to Thompson-Epstein scoring system,hip function was excellent in 5 cases,good in 2 cases and fair in 1 case.Conclusion： The anterolateral approach of hip joint can not only retain the residual blood supply of femoral head,but also fully expose the acetabulum and femoral head. It is a relatively ideal surgical approach for the treatment of Pipkin typeⅠand typeⅡfractures.

关 键 词：髋脱位 股骨头 骨折 手术入路 

分 类 号：R687.3[医药卫生—骨科学]