| 改良Smith-Peterson和Hardinge入路治疗PipkinⅠ型及Ⅱ型股骨头骨折的病例对照研究 |
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Received:March 20, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 蒋煜青 |
JIANG Yu-qing |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
jiangyq77@126.com |
| 黄健 |
HUANG Jian |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
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| 郭伟康 |
GUO Wei-kang |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
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| 赖兵 |
LAI Bing |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
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| 王军 |
WANG Jun |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
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| 梁传兴 |
LIANG Chuan-xing |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
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| 刘松浪 |
LIU Song-lang |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
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| 林伟明 |
LIN Wei-ming |
广东中山大学附属梅州医院 梅州市人民医院关节外科, 广东 梅州 514031 |
Department of Joint Surgery, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou 514031, Guangdong, China |
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| 期刊信息：《中国骨伤》2017年30卷，第7期，第616-621页 |
| DOI：10.3969/j.issn.1003-0034.2017.07.007 |
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目的：对比改良Smith-Peterson （S-P）入路与改良Hardinge入路在PipkinⅠ、Ⅱ型股骨头骨折手术治疗中的临床疗效。
方法：回顾性分析2005年7月至2014年7月收治并随访的42例PipkinⅠ、Ⅱ型股骨头骨折的资料，其中前方组（采用改良S-P入路）23例，男17例，女6例，年龄（29.3±9.4）岁，5例Ⅰ型骨折行骨块切除，3例Ⅰ型和15例Ⅱ型骨折行内固定；外侧组（采用改良Hardinge入路）19例，男15例，女4例，年龄（31.4±10.0）岁，3例Ⅰ型骨折行骨块切除，4例Ⅰ型和12例Ⅱ型骨折行内固定。比较两组患者的术中时间、出血量与骨折愈合时间，采用Thompson-Epstein评分对术后疗效进行评价，比较髋关节复位时间（<6 h、6~12 h、>12 h）及手术时机（≤ 24 h、>24 h）与术后疗效的关系。
结果：所有患者获得随访，时间24~60个月，平均（30.29±6.95）个月。前方组手术时间（61.96±12.22） min、术中出血量（46.09±18.03） ml优于外侧组手术时间（74.74±10.06） min、术中出血量（72.11±19.88） ml （P<0.05）；前方组骨折愈合时间（12.22±1.70）周，术后疗效评定，优8例，良10例，可4例，差1例，优良率78.3%，股骨头缺血坏死发生率8.69%（2/23）、异位骨化发生率13.04%（3/23）；外侧组骨折愈合时间（12.42±1.95）周，术后疗效评定，优6例，良7例，可3例，差3例，优良率68.4%，股骨头缺血坏死发生率10.53%（2/19）、异位骨化发生率5.26%（1/19）。两组患者在骨折愈合时间、术后疗效评定及并发症发生率等方面比较，差异无统计学意义（P>0.05）。髋关节脱位复位时间<6 h与6~12 h患者疗效均明显优于>12 h复位者，而复位时间<6 h和6~12 h之间疗效差异无统计学意义。伤后≤ 24 h与>24 h手术治疗患者术后疗效比较差异无统计学意义。
结论：PipkinⅠ、Ⅱ型股骨头骨折伤后髋关节脱位应尽早（<6 h）闭合复位，若条件限制也应在12 h内完成复位。采用改良Smith-Peterson入路与改良Hardinge入路手术治疗PipkinⅠ、Ⅱ型股骨头骨折最终可获得满意的中期疗效，但前者更具有创伤小、出血少、手术时间短的优点。 |
| [关键词]:股骨头 骨折 髋脱位 手术入路 病例对照研究 |
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| Treatment of Pipkin typeⅠandⅡfemoral head fractures through modified Smith-Peterson approach and modified Hardinge approach-a case-control studies |
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Abstract:
Objective: To compare clinical results of treatment of Pipkin typeⅠand Ⅱ femoral head fractures through modified Smith-Peterson(S-P) approach and modified Hardinge approach.
Methods: From July 2005 to July 2014,42 patients with Pipkin typeⅠand Ⅱ femoral head fractures were treated with operation. A total of 23 patients in anterior group was treated with modified S-P approach including 17 males and 6 females with an average age of (29.3±9.4) years old,5 cases of typeⅠby excision of the fragement,3 cases of typeⅠand 15 cases of typeⅡcases by fixation of the fragement. While a total of 19 patients in the lateral group was treated with modified Hardinge approach including 15 males and 4 females with an average age of (31.4±10.0) years old,3 cases of type Ⅰby excision of the fragement,4 cases of typeⅠand 12 cases of type Ⅱ by fixation of the fragement. Operative time,blood loss during operation and fracture healing time were observed and compared. The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale. The effect of hip reduction time of less than 6 h,6 to12 h,and more than 12 h,the effect of surgery time within 24 h and more than 24 h after injury were compared.
Results: All patients were followed up from 24 to 60 months with an average of(30.29±6.95) months. The operation time (61.96±12.22) min,blood loss (46.09±18.03) ml,and (74.74±10.06) min,blood loss (72.11±19.88) ml in lateral group in the anterior group were better than those of lateral group(P<0.05). In anterior group,fracture healing time was(12.22±1.70) weeks,the results were excellent in 8 cases,good in 10 cases,fair in 4 cases and poor in 1 case,the excellent and good rate was 78.3%,the incidence of avascular necrosis of femoral head was 8.69%(2/23),and the incidence of heterotopic ossification was 13.04%(3/23). While in lateral group,the fracture healing time was(12.42±1.95) weeks,the results were excellent in 6 cases,good in 7 cases,fair in 3 cases and poor in 3 cases,the excellent and good rate was 68.4%,the incidence of avascular necrosis of femoral head was 10.53%(2/19),and the incidence of heterotopic ossification was 5.26%(1/19). There was no significant difference in fracture healing time,postoperative effect and postoperative complications between the anterior group and lateral group(P 0.05). The effect of patients with reduction time of hip dislocation less than 12 h was significantly better than that of more than 12 h,there was no significant difference in the effect between reduction time within 6 h and 6 to 12 h. There was no significant difference in the outcome between surgical patients within 24 h and more than 24 h after injury.
Conclusion: Dislocated hip of Pipkin typeⅠand Ⅱ femoral head fractures should be closed reduction within 6 h. If conditions are limited,the reduction time can be accepted within 12 h. Both of modified S-P approach and modified Hardinge approach are effective in treating Pipkin typeⅠand Ⅱ femoral head fractures,and can obtain excellent outcomes. Moreover,modified S-P approach has advantage of less trauma,less blood loss,shorter operative time. |
| KEYWORDS:Femur head Fractures Hip dislocation Surgical approach Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 蒋煜青,黄健,郭伟康,赖兵,王军,梁传兴,刘松浪,林伟明.改良Smith-Peterson和Hardinge入路治疗PipkinⅠ型及Ⅱ型股骨头骨折的病例对照研究[J].中国骨伤,2017,30(7):616~621 |
| 英文格式: | JIANG Yu-qing,HUANG Jian,GUO Wei-kang,LAI Bing,WANG Jun,LIANG Chuan-xing,LIU Song-lang,LIN Wei-ming.Treatment of Pipkin typeⅠandⅡfemoral head fractures through modified Smith-Peterson approach and modified Hardinge approach-a case-control studies[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(7):616~621 |
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