Ganz入路治疗Pipkin Ⅳ型骨折的临床疗效  

Clinical efficacy of Ganz approach in the treatment of Pipkin Ⅳ fractures

作　　者：汪智文 陈明[2] 罗浩 刘赣赣 张雪龙 WANG Zhiwen;CHEN Ming;LUO Hao;LIU Gangan;ZHANG Xueong(Trauma Center,The First Affiliated Hospital of Nanchang University,Nanchang 330006;Orthopaedic Hospital,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院创伤中心,南昌330006 [2]南昌大学第一附属医院骨科医院,南昌330006

出　　处：《中华骨与关节外科杂志》2023年第7期601-605,共5页Chinese Journal of Bone and Joint Surgery

基　　金：国家自然科学基金(82060878);江西省教育厅课题项目(GJJ170051,GJJ210221)。

摘　　要：目的:探讨采用Ganz入路(髋关节外科脱位入路)治疗Pipkin Ⅳ型骨折的临床疗效。方法:2016年1月至2022年2月采用Ganz入路治疗39例Pipkin Ⅳ型骨折患者。记录手术时间、术中出血量、骨折愈合时间、髋关节异位骨化及股骨头缺血性坏死等发生率。采用髋关节Harris评分评估术前和术后1年的髋关节功能恢复情况。结果:39例患者均顺利完成手术,术中出血量为90~200 mL,平均(140±37)mL;手术时间100~180 min,平均(148±40)min,骨折复位满意。39例患者术后随访12~52个月,平均(35.6±15.7)个月。通过复查X线片示大转子截骨及股骨头和髋臼骨折均达到骨性愈合,大转子截骨愈合时间为2~5个月,平均(3.4±1.2)个月,股骨头骨折愈合时间为3~12个月,平均(6.9±2.5)个月。术前及术后1年髋关节Harris评分为(52.4±6.8)分和(89.4±7.6)分,差异有统计学意义(P<0.001)。无一例患者发生骨不连、异位骨化及股骨头缺血坏死等并发症。结论:Ganz入路治疗PipkinⅣ型骨折时,既能保护股骨头的血供,又能充分暴露髋关节及股骨头等,临床效果满意,值得临床推广。Objective:To explore the clinical effect of Ganz approach(surgical dislocation approach of hip joint)in the treatment of Pipkin Ⅳ fractures.Methods:Data of 39 patients with Pipkin Ⅳ fractures treated with Ganz approach from January 2016 to February 2022 were retrospectively analyzed.The operation time,intraoperative blood loss,fracture healing time,and incidences of heterotopic ossification of hip joint and avascular necrosis of femoral head were recorded.The function of hip joint was evaluated by hip Harris score before operation and one year after operation.Results:All patients completed the operation successfully.The average intraoperative blood loss was(140±37)mL(range,90-200 mL).The average operation time was(148±40)min(range,100-180 min).All patients had satisfactory fracture reduction.All patients were followed up for 12-52 months with the mean of(35.6±15.7)months.X-ray or CT showed that greater trochanter osteotomy and acetabular fractures both achieved bony healing,the average healing time of greater trochanter osteotomy was(3.4±1.2)months(range,2-5 months),and the average healing time of femoral head fractures was(6.9±2.5)months(range,3-12 months).The Harris scores of hip joint before and one year after operation were(52.4±6.8)and(89.4±7.6)respectively with the difference statistically significant(P<0.001).Conclusions:Ganz approach can not only protect the blood supply of femoral head,but also fully expose the operative fields such as hip joint and femoral head,and obtain satisfying clinical results,which is worthy of clinical application.

关 键 词：股骨头骨折 髋臼骨折 手术入路 内固定 大转子截骨 

分 类 号：R683.42[医药卫生—骨科学]