摘要
目的探讨直接前入路Herbert钉固定治疗青年PipkinⅡ型股骨头骨折的临床疗效。方法回顾性分析2016年8月至2018年6月期间华中科技大学同济医学院附属协和医院骨科收治的16例青年PipkinⅡ型股骨头骨折患者资料。男9例,女7例;年龄为18~45岁,平均25.6岁。10例伴有髋关节后脱位的患者入院后急诊(<6 h)行髋关节复位,复位成功后行手术固定。所有患者均采用直接前入路Herbert钉固定。记录患者的手术切口长度、手术时间、术中出血量、住院时间、髋关节Harris评分、疗效及并发症的发生情况等。结果本组患者的手术切口长度平均为10.4 cm,手术时间平均为45.6 min,术中出血量平均为46.5 mL,住院时间平均为4.0 d。16例患者术后获11~15个月(平均12.7个月)随访。术前、术后3个月、术后6个月、术后9个月及末次随访时髋关节Harris评分分别为(14.3±2.2)、(64.8±2.4)、(81.1±4.9)、(88.1±4.6)、(91.9±3.4)分,各时间点之间两两比较差异均有统计学意义(P<0.05)。末次随访时根据Thompson-Epstein临床评价标准评定疗效:优9例,良6例,可1例。随访期间无一例患者发生股骨头缺血性坏死、异位骨化等并发症。结论对于年轻的PipkinⅡ型股骨头骨折患者,通过直接前入路Herbert钉固定骨折,易于显露、操作,不加重股骨头血供损伤,可降低异位骨化的发生率,且手术时间短,近期疗效良好。
Objective To evaluate Herbert screwing directly via the anterior approach for femoral head fractures of Pipkin typeⅡin the youth.Methods A retrospective analysis was conducted of the 16 patients who had been treated at Department of Orthopaedics,Union Hospital,Tongji Medical College for femoral head fractures of Pipkin typeⅡfrom August 2016 to June 2018.They were 9 men and 7 women,aged from 18 to 45 years(mean,25.6 years).Of them,10 cases who had been complicated with posterior dis-location of the hip received emergency hip reduction(<6 h)before surgical fixation.All the patients underwent Herbert screwing directly via the anterior approach.Their incision length,operation time,intraoperative blood loss,hospitalization time,Harris hip scores,therapeutic efficacy and complications were recorded.Results In this series,the incision length averaged 10.4 cm,operation time 45.6 min,intraoperative blood loss 46.5 mL,and hospitalization time 4.0 d.All the 16 patients were followed up for 11 to 15 months(average,12.7 months).Their Harris hip scores at preoperation,3,6 and 9 months postoperation and at the last follow-up were,respectively,14.3±2.2,64.8±2.4,81.1±4.9,88.1±4.6 and 91.9±3.4 points,showing a significant difference between any 2 time points(P<0.05).The therapeutic efficacy at the last follow-up by the Thompson-Epstein clinical evaluation was assessed as excellent in 9 cases,as good in 6 and as fair in one.No osteonecrosis of the femoral head or heterotopic ossification was observed by follow-up.Conclusion For young patients with femoral head fracture of Pipkin typeⅡ,Herbert screwing directly via the anterior approach provides easy exposure and manipulation,does not aggravate the blood supply to the femoral head,decreases incidence of heterotopic ossification,and leads to shorter operation time and quick functional recovery of the hip.
作者
曹发奇
薛航
周武
夏天
刘梦非
邵增务
韩艳久
刘静
刘国辉
Cao Faqi;Xue Hang;Zhou Wu;Xia Tian;Liu Mengfei;Shao Zengwu;Han Yanjiu;Liu Jing;Liu Guohui(Department of Orthopaedics,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2019年第12期1047-1051,共5页
Chinese Journal of Orthopaedic Trauma
基金
国家科技部重点研发计划(2018YFC2001500,2018YFC2001502)
国家卫计委重大疾病科技行动防治计划(ZX-01-018,ZX-01-C2016153)
国家自然科学基金(81772345)。
关键词
股骨头骨折
骨折固定术
内
外科手术
微创性
手术入路
Femoral head fractures
Fracture fixation
internal
Surgical procedures
minimally invasive
Surgical approach
