髋关节外侧入路在Pipkin骨折治疗中的应用

第一作者：叶少腾

2011-06-01 点击量：1290 　　我要说

叶少腾，陈凯宁，陈嘉欣，陈海波，张金旋，李振宇

摘要：目的探讨髋关节外侧入路在Pipkin骨折治疗中的应用效果.方法回顾性研究1999年5月至2008年1月采用髋关节外侧入路治疗的13例Pipkin骨折患者资料,均为男性,年龄19～59岁,平均34.5岁.Pipkin分型:Ⅰ型4例,Ⅱ型5例,Ⅲ型2例,Ⅳ型2例.股骨头骨折采用可吸收螺钉固定,髋臼骨折采用皮质骨螺钉固定,股骨颈骨折采用拉力螺钉固定.从骨折愈合情况、创伤性关节炎、股骨头缺血性坏死、异位骨化以及Thompson-Epstein评分等方面评价治疗效果.结果 13例患者术后获平均48.5个月(13～105个月)随访.X线片及CT示所有患者骨折均获得愈合.随访期间无感染、内固定失效、螺钉断裂等并发症发生.1例Ⅲ型骨折患者股骨颈骨折属于头下型,术后出现股骨头缺血性坏死,于30个月后行全髋关节置换术.1例Ⅳ型骨折患者由于关节面软骨碎块多且小而无法固定,术中予清除,继发创伤性关节炎,应用非甾体类药物控制症状.Brooker异位骨化分级:Ⅰ级1例,Ⅱ级2例,Ⅲ级1例.Thompson-Epstein评分:优6例,良4例,可2例,差1例,优良率为76.9%.结论髋关节外侧入路可充分显露、固定髋臼后壁骨折及股骨头骨折,且疗效满意,是治疗Pipkin骨折的较理想入路.

Abstract：Objective To investigate the clinical results of lateral hip approach used in the treatment of Pipkin fractures. Methods We retrospectively reviewed 13 male patients who had been treated for Pipkin fractures through lateral hip approach between May 1999 and January 2008. They were all male. Their mean age was 34.5 (rang, 19 to 59) years. According to the Pipkin classification, there were 4 cases of type Ⅰ, 5 type Ⅱ, 2 type Ⅲ and 2 type Ⅳ. All the femoral head fractures were fixed by absorbable screws. Lag screws were used for fixation of acetabular and femoral neck fractures. The outcomes were estimated by indexes like radiographic union, traumatic arthritis, avascular necrosis of the femoral head, heterotopic ossification and Thompson-Epstein scores. Results The mean follow-up time was 48.5 (13 to 105) months. All the patients obtained radiographic union of the fracture. One suffered traumatic arthritis, one avascular necrosis of the femoral head and 4 heterotopic os-sification. By the Thompson-Epstein scoring scale, 6 patients had excellent results, 4 good, 2 fair and one poor. The rate of good to excellent was 76.9%. Conclusion Since the lateral hip approach allows sufficient si-multaneous exposure and fixation of the posterior acetabular wall and femoral head fractures, it may be an ideal surgical approach for the treatment of Pipkin fractures with satisfactory results.

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