| Herbert螺钉治疗Pipkin骨折的临床疗效分析 |
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投稿时间：2015-05-18
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| 作者 | Author | 单位 | Address | E-Mail |
| 胡联英 |
HU Lian-ying |
合肥市第二人民医院骨科, 安徽 合肥 230011 |
Department of Orthopaedics, the 2nd People's Hospital of Hefei, Hefei 230011, Anhui, China |
huliany8007@sina.com |
| 贾其余 |
JIA Qi-yu |
合肥市第二人民医院骨科, 安徽 合肥 230011 |
Department of Orthopaedics, the 2nd People's Hospital of Hefei, Hefei 230011, Anhui, China |
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| 俞宇 |
YU Yu |
合肥市第二人民医院骨科, 安徽 合肥 230011 |
Department of Orthopaedics, the 2nd People's Hospital of Hefei, Hefei 230011, Anhui, China |
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| 曹溢 |
CAO Yi |
合肥市第二人民医院骨科, 安徽 合肥 230011 |
Department of Orthopaedics, the 2nd People's Hospital of Hefei, Hefei 230011, Anhui, China |
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| 郑曙翘 |
ZHENG Shu-qiao |
合肥市第二人民医院骨科, 安徽 合肥 230011 |
Department of Orthopaedics, the 2nd People's Hospital of Hefei, Hefei 230011, Anhui, China |
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| 期刊信息：《中国骨伤》2016年，第29卷，第2期，第162-166页 |
| DOI：10.3969/j.issn.1003-0034.2016.02.016 |
| 基金项目: |
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中文摘要:
目的:探讨应用Herbert螺钉内同定治疗Pipkin Ⅰ、Ⅱ型股骨头骨折的效果.
方法:自2008年1月至2012年12月,对23例PipkinⅠ、Ⅱ型股骨头骨折患者采用Kocher-Langenbeck入路切开复位、Herbert螺钉内固定进行治疗.其中男18例,女5例;年龄18~52岁,平均35.5岁;左侧8例,右侧15例.均为股骨头骨折合并髋关节后脱位,其中PipkinⅠ型股骨头骨折5例,PipkinⅡ型股骨头骨折18例.入院后至手术时间6~72 h,平均32 h.临床和影像学结果测量按Thompson-Epstein评分法评定,采用髋关节Harris评分(HHS)量表对末次随访时的髋关节功能进行评定,并与健侧对比.
结果:23例均获随访,时间20~48个月,平均30个月,按Thompson-Epstein评分法评定疗效:优12例,良6例,中4例,差1例.根据髋关节Harris评分(HHS)量表评分:末次随访患侧评分66~95分,平均(87.80±8.46)分;健侧评分72~98分,平均(90.10±6.35)分,差异无统计学意义(t=1.044,P=0.302).术后无深部感染、深静脉血栓形成等并发症发生.4例术后3年出现股骨头缺血性坏死,1例术后1年即出现髋关节行走后疼痛,外伤后螺钉松动移位,出现较严重的创伤性关节炎并发症,均行全髋关节置换处理.
结论:采用Kocher-Langenbeck入路、Herbert螺钉内固定治疗PipkinⅠ、Ⅱ型股骨头骨折效果显着,是一种可靠的值得推荐的治疗方法.但此类骨折术后可能会出现股骨头缺血性坏死及创伤性关节炎并发症,在临床工作中应积极注意观察,做好预防及治疗措施. |
| 【关键词】股骨骨折 内固定器 Herbert螺钉 |
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| Clinical effects of internal fixation with Herbert screws for the treatment of Pipkin femoral head fractures |
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ABSTRACT
Objective:To explore the therapeutic effects of internal fixation with Herbert screws for the treatment of Pipkin typeⅠand typeⅡfemoral head fractures.
Methods:From January 2008 to December 2012,23 patients with Pipkin typeⅠand typeⅡfemoral head fractures were treated with open reduction and internal fixation by Herbert screws through Kocher-Langenbeck approach. Twenty-three patients (aged 18 to 52 years with a mean of 35.5 years,including 18 males and 5 females patients,8 left hips and 15 right hips) with femoral head fractures and posterior hip dislocation. The fracture was classified according to Pipkin classification based on the radiographic findings,5 patients had typeⅠand 18 had typeⅡfractures. The duration time from admission to the operation ranged from 6 to 72 h (averaged 32 h). The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale. The Harris hip score(HHS) was used to evaluate and compare hip functions at the latest follow-up between affected and healthy sides.
Results:All the patients were followed up,and the duration ranged from 20 to 48 months(averaged 30 months). According to Thompson-Epstein system,12 patients got an excellent result,6 good,4 fair and 1 poor. The average HHS at the finial follow-up was 87.80±8.46 (ranged from 66 to 95),which is similar to that in the healthy side 90.10±6.35(ranged from 72 to 98)(t=1.044,P=0.302). The complications such as deep infection,and deep vein thrombosis were not found. At the 3rd year during follow-up,4 patients had avascular necrosis of femoral head. At the 1st year of follow-up,1 patient had hip pain after walking,screws loosening and shift after trauma,and serious complications of traumatic arthritis. All the 5 patients were treated with total hip arthroplasties.
Conclusion:The treatment of internal fixation with Herbert screws through the Kocher-Langenbeck approach is effective for Pipkin typeⅠand typeⅡfemoral head fracture. The method is reliable and valuable for recommendation. However,such fracture may have avascular necrosis of femoral head and complication of traumatic arthritis,which should be observed carefully in clinic with preparation of the prevention and treatment measures. |
| KEY WORDS Femoral fractures Internal fixator Herbert screws |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 胡联英,贾其余,俞宇,曹溢,郑曙翘.Herbert螺钉治疗Pipkin骨折的临床疗效分析[J].中国骨伤,2016,29(2):162~166 |
| 英文格式: | HU Lian-ying,JIA Qi-yu,YU Yu,CAO Yi,ZHENG Shu-qiao.Clinical effects of internal fixation with Herbert screws for the treatment of Pipkin femoral head fractures[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(2):162~166 |
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