髋臼骨折合并同侧股骨颈骨折的特点及治疗策略研究  

Characteristics and treatment of acetabular fracture combined with ipsilateral femoral neck fracture

作　　者：洪顾麒[1] 庆思源 胡军[1] 张宇[1] 秦晓东[1] Hong Guqi;Qing Siyuan;Hu Jun;Zhang Yu;Qin Xiaodong(Department of Orthopaedics,The First Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院骨科,南京210029

出　　处：《中华创伤骨科杂志》2022年第12期1088-1093,共6页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨髋臼骨折合并同侧股骨颈骨折的损伤特点、治疗策略及疗效。方法回顾性分析2009年1月至2021年6月期间南京医科大学第一附属医院及合作医院骨科收治的15例髋臼骨折合并同侧股骨颈骨折患者资料。男10例, 女5例;年龄为26~68岁, 平均47.1岁。根据损伤特点选择治疗方式:3例无髋关节脱位且股骨颈骨折不完全移位者, 股骨颈骨折行闭合复位内固定;7例无髋关节脱位但股骨颈骨折完全移位者, 股骨颈骨折先尝试闭合复位, 不成功则行切开复位内固定;5例合并髋关节脱位(2例前脱位和3例后脱位)者, 股骨颈骨折行切开复位内固定。髋臼骨折根据其分型选择合适手术入路固定。记录患者的手术时间、术中出血量、骨折愈合情况、患髋功能及随访期间股骨头缺血性坏死(NFH)等并发症的发生情况。结果本组患者手术时间为170~540 min, 平均210 min;术中出血量为300~7 900 mL, 平均800 mL。术后X线片示所有髋臼骨折和股骨颈骨折均达到解剖复位或满意复位。15例患者术后获1~13年(平均4年)随访。1例患者术后1年因骨折不愈合而行全髋关节置换术, 其余14例患者骨折均一期愈合。末次随访时根据Merle d’Aubigné & Postel评分标准评定患髋功能:优3例, 良6例, 差6例。4例患者术后出现NFH, 其中1例无髋关节脱位, 3例合并髋关节脱位。1例患者术后出现异位骨化。结论髋臼骨折合并同侧股骨颈骨折术后NFH发生率较高, 且合并髋关节脱位者更容易发生NFH。根据损伤特点采用不同的治疗策略, 并注意尽量保护股骨头血供, 可明显改善预后。Objective:To investigate the injury characteristics, treatment strategy and prognosis of acetabular fracture combined with ipsilateral femoral neck fracture.Methods:A retrospective analysis was conducted of the 15 patients with acetabular fracture combined with ipsilateral femoral neck fracture who had been treated from January 2009 to June 2021 at Department of Orthopaedics, The First Hospital Affiliated to Nanjing Medical University. They were 10 males and 5 females, aged from 26 to 68 years (average, 47.1 years). The treatment strategy depended on their injury characteristics. For the 3 patients with incomplete displacement of the femoral neck fracture but no hip dislocation, the femoral neck fracture was treated by closed reduction and internal fixation;for the 7 patients with complete displacement of the femoral neck fracture but no hip dislocation, the femoral neck fracture was treated first by closed reduction and then by open reduction and internal fixation in case the closed reduction had failed;for the 5 patients complicated with hip dislocation (anterior one in 2 cases and posterior one in 3 cases), the femoral neck fracture was treated by open reduction and internal fixation. The acetabular fractures were treated via an appropriate surgical approach depending on their classifications. The operation time, intraoperative bleeding, fracture healing, functional recovery and complications such as postoperative avascular necrosis of the femoral head (NFH) were recorded.Results:In this cohort, the operation time ranged from 170 to 540 min, averaging 210 min, and the amount of intraoperative bleeding from 300 to 7,900 mL, averaging 800 mL. Postoperative X-ray films showed that all acetabular fractures and femoral neck fractures achieved anatomical reduction or satisfactory reduction. All patients were followed up for 1 to 13 years (average, 4 years). One patient had to receive total hip arthroplasty due to nonunion one year after operation, and the fractures in the other 14 patients healed by the first intent

关 键 词：髋臼 骨折 股骨颈骨折 股骨头坏死 骨折分型 骨折固定术 内 

分 类 号：R687.3[医药卫生—骨科学]