联合入路开放复位内固定髋臼后壁合并股骨头骨折  

Combined approaches for open reduction and internal fixation of acetabular posterior wall factures accompanied with femoral head fractures

作　　者：胡宗亮 王祥华 耿国波 郑磊[1] 穆卫东[1] HU Zong-liang;WANG Xiang-hua;GENG Guo-bo;ZHENG Lei;MU Wei-dong(Department of Traumatic Orthopedics,Shandong Provincial Hospital,Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院创伤骨科,山东济南250021

出　　处：《中国矫形外科杂志》2021年第20期1905-1908,共4页Orthopedic Journal of China

摘　　要：[目的]探讨Kocher-Langenbeck(K-L)入路联合Smith-Petersen(S-P)入路治疗髋臼后壁合并股骨头骨折(PipkinⅣ型骨折)的临床效果。[方法]回顾性分析2015年1月-2020年1月本院采用K-L联合S-P入路开放复位内固定治疗PipkinⅣ型骨折的9例患者的临床资料。[结果]9例患者均顺利完成手术,术中无重要血管、神经损伤等严重并发症,手术时间(137.78±41.77)min,术中出血量平均(311.11±113.96)ml。Harris评分由术后3个月的(57.89±4.73)分,显著增加至术后6个月的(76.33±3.50)分,术后12个月的(88.67±3.50)分,术后36个月的(92.11±2.09)分(P<0.001)。至末次随访时,9例患者中,6例恢复至伤前运动能力水平,3例仍未恢复至伤前运动能力水平。影像方面,根据Matta评价标准,术后X线片及CT显示骨折复位质量,优8例,良1例。至末次随访时,所有患者均未见异位骨化,无股骨头坏死;髋关节间隙正常6例,轻度狭窄2例,明显狭窄1例。[结论]K-L联合S-P入路可有效复位固定PipkinⅣ型骨折,临床效果满意。[Objective]To explore the clinical efficiency of Kocher-Langenbeck(K-L)approach combined with Smith-Petersen(S-P)approach for open reduction and internal fixation(ORIF)of acetabular posterior wall factures accompanied with femoral head fractures(Pip-kin typeⅣfractures).[Methods]A retrospective study was conducted on 9 patients who underwent ORIF of Pipkin typeⅣfractures through K-L combined with S-P approach in our hospital from January 2015 to January 2020.[Results]All the 9 patients were successful-ly operated on without serious complications,such as important blood vessel and nerve damage,while with operation time of(137.78±41.77)minutes,and intraoperative blood loss of(311.11±113.96)ml.The Harris score increased significantly from(57.89±4.73)at 3 months to(76.33±3.50)at 6 months,(88.67±3.50)at 12 months,and(92.11±2.09)at 36 months postoperatively(P<0.001).By the time of latest follow-up,6 of the 9 patients had recovered to the level of pre-injury sports capacity,whereas the other 3 patients remained under the level of pre-injury sports capacity.In terms of imaging evaluation,quality of fracture reduction on radiographs was graded as excellent in 8 patients and good in 1 patient according to Matta's criteria.To the latest follow-up,no heterotopic ossification and femoral head necrosis on images were found in anyone of them,in addition,the hip joint space was normal in 6 cases,mildly narrowed in 2 cases,and obviously narrowed in only 1 case.[Conclusion]The K-L combined with S-P approach does provide an effective exposure for reduction and fixa-tion of Pipkin typeⅣfractures,and achieve satisfactory clinical outcomes.

关 键 词：PIPKIN Ⅳ型骨折 髋臼后壁骨折 股骨头骨折 手术入路 

分 类 号：R683.42[医药卫生—骨科学]