Ganz入路内固定治疗Pipkin Ⅳ型股骨头骨折的疗效分析  

Treatment of PipkinⅣfemoral head fracture by internal fixation via the Ganz approach

作　　者：孙守斌 樊俊俊 李岩 罗鸣 党海峰 袁志 Sun Shoubin;Fan JunJun;Li Yan;Luo Ming;Dang Haifeng;Yuan Zhi(Department of Orthopaedics,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院骨科,西安710032

出　　处：《中华创伤骨科杂志》2021年第6期489-494,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨Ganz入路内固定治疗PipkinⅣ型股骨头骨折的临床疗效。方法回顾性分析2013年3月至2019年4月期间空军军医大学西京医院骨科收治的7例PipkinⅣ型股骨头骨折患者资料。男5例,女2例;年龄为23~66岁,平均40.5岁。受伤至手术时间为5~13 d,平均7.3 d。7例患者均应用Ganz入路,股骨头骨折采用双头加压螺钉固定,髋臼骨折采用螺钉联合重建钢板固定。记录患者的手术时间、术中出血量、骨折复位质量、末次随访时髋关节功能及并发症发生情况等。采用髋关节Harris评分标准评定髋关节功能。结果本组患者的手术时间为155~235 min,平均197.9 min;术中出血量为450~765 mL,平均590.0 mL。7例患者术后获12~86个月(平均34.4个月)随访。髋臼骨折术后复位质量根据Letournel推荐标准评定:解剖复位6例,满意复位1例;股骨头骨折术后复位质量根据Thompson-Epstein临床和影像学评价标准评定:优6例,良1例。末次随访时7例患者的髋关节Harris评分为92~97分,平均93.0分。随访期间1例患者发生创伤性关节炎,目前仍在观察随访;2例患者出现患肢肌静脉血栓,经规范治疗后机化。结论Ganz入路内固定治疗PipkinⅣ型股骨头骨折具有骨折复位质量优、髋关节功能恢复好等优点。Objective To evaluate the Ganz approach in the internal fixation of PipkinⅣfemoral head fracture.Methods The data of 7 patients with PipkinⅣfemoral head fracture were retrospectively analyzed who had been admitted to Department of Orthopaedics,Xijing Hospital from March 2013 to April 2019.They were 5 males and 2 females,aged from 23 to 66 years(average,40.5 years).The time from injury to operation ranged from 5 to 13 days(average,7.3 days).In all the 7 patients,the Ganz approach was adopted in the internal fixation with double-head compression screws for femoral head fracture and in the internal fixation with screws plus a reconstruction plate for acetabular fracture.Their operation time,intraoperative bleeding,fracture reduction,hip functional recovery and complications were recorded.The hip function was assessed by Harris hip score.Results Their operation time ranged from 155 to 235 min(mean,197.9 min)and their intraoperative bleeding from 450 to 765 mL(mean,590.0 mL).This cohort was followed up for 12 to 86 months(mean,34.4 months).According to the Letournel recommended criteria for reduction quality of acetabular fractures,anatomical reduction was achieved in 6 cases and satisfactory reduction in one;according to the Thompson-Epstein clinical and imaging evaluation,the reduction of femoral head fracture was excellent in 6 cases and good in one.Their Harris hip scores at the last follow-up ranged from 92 to 97(mean,93.0).Traumatic arthritis developed in one case which was still under observation and muscular vein thrombosis developed in the affected limb in 2 cases but was organized after standard treatment.Conclusion In the treatment of PipkinⅣfemoral head fracture,the Ganz approach can lead to good reduction quality and fine functional recovery of the hip.

关 键 词：股骨头 髋臼 骨折 骨折固定术 内 手术入路 

分 类 号：R687.3[医药卫生—骨科学]