Usefulness of arthroscopic surgery in hip trauma cases

Purpose: The goal of this study is to clarify the usefulness of arthroscopic surgery as an adjunct in the management of hip trauma. Type of Study: Clinical case series. Methods: Eleven joints from 10 hip trauma cases were studied. All joints had been injured in traffic accidents. Seven joints were classified as Thompson and Epstein (T-E) type I, 2 joints as type II, and 1 joint as type IV. The remaining case was a fracture of the acetabular weight-bearing region that was not included within these classifications. The 5 femoral head fractures associated with hip dislocation were further classified according to Pipkin: 3 joints were type 1, 1 joint was type 2, and 1 joint was type 3. The interval from injury to arthroscopy ranged from 1 to 7 days, with a mean of 3.2 days. Results: In 7 cases, small free osteochondral or chondral fragments that were not detectable on either plain radiographs or computed tomography scans were seen arthroscopically. These fragments were debrided. Arthroscopic osteosynthesis using absorbable pins and fragment extraction were performed in 1 case each of the Pipkin's type 1 femoral head fractures. In the case of the acetabular weight-bearing region fracture, reduction and percutaneous pinning were performed under arthroscopic observation. After a mean postoperative follow-up period of 9 years and 6 months, no abnormalities were observed in 9 of the joints. However, the T-E type IV joint developed osteoarthritis and the Pipkin type 3 joint developed aseptic osteonecrosis of the femoral head. Conclusions: Arthroscopic surgery allows procedures such as washout and debridement of small free osteochondral and chondral fragments, which were previously neglected in T-E type I and II dislocations despite the fact that they may cause osteoarthritis. In addition, arthroscopic surgery allows procedures such as the extraction or osteosynthesis of fracture fragments in cases associated with femoral head fractures.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 269–273     

髋关节外侧入路在Pipkin骨折治疗中的应用

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.     

Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both

To determine the prognosis and best treatment for patients who have a posterior dislocation of the hip associated with a fracture of the femoral head or neck (Grade IV, according to the classification of Stewart and Milford), we surveyed the records of 201 patients who had been treated for 203 posterior dislocations from 1958 to 1985 and selected the cases of 19 patients (19 posterior fracture-dislocations of the hip) for further review. Each of the injuries had resulted from a motor-vehicle accident. Thirteen patients had had a posterior dislocation with an associated fracture of the femoral head located either caudad or cephalad to the fovea centralis (Pipkin Type-I or Type-II injury), one had had a posterior dislocation with associated fractures of the femoral head and neck (Pipkin Type III), two had had a posterior dislocation with associated fractures of the femoral head and the acetabular rim (Pipkin Type IV), and three had had a fracture-dislocation that we could not categorize according to the Pipkin classification. Twelve patients had been treated by closed reduction for a Type-I or Type-II injury; one, by open reduction after an unsuccessful closed reduction for a Type-I injury; one, by primary total hip replacement for a Type-III injury; and three, by open reduction with screw fixation of the acetabular fracture and removal of the fragment of the head for two Type-IV injuries and one unclassified injury. An additional two patients had had both a fracture of the femoral neck and a dislocation; one hip was treated primarily with a Moore prosthesis and the other was left unreduced.(ABSTRACT TRUNCATED AT 250 WORDS)     

直接前方入路联合直接后方入路治疗PipkinⅣ型股骨头骨折

目的探讨直接前方入路(direct anterior approach,DAA)联合直接后方入路(direct posterior approach,DPA)治疗PipkinⅣ型股骨头骨折的疗效。方法回顾性分析2016年1月至2019年4月采用DAA联合DPA入路治疗18例PipkinⅣ型股骨头骨折患者资料,男13例,女5例;年龄19~56岁,平均43.2岁;车祸伤15例,高处坠落伤3例;13例股骨头骨折线位于股骨头凹下方,5例骨折线位于股骨头凹上方;髋臼骨折按Letournel-Judet分型:后壁骨折14例,后柱伴后壁骨折2例,横断伴后壁骨折2例。采用DAA入路处理股骨头骨折,采用DPA入路处理髋臼骨折。术后行骨盆X线及CT检查,评价骨折复位、愈合情况及股骨头坏死、坐骨神经损伤、臀上血管神经损伤、异位骨化等情况;按照Matta影像学标准评价髋臼复位质量;采用Thompson-Epstein评分系统评价髋关节功能。结果18例患者手术时间75~205 min,平均133 min;术中出血240~600 ml,平均371 ml。所有患者手术切口一期愈合。18例患者均获得随访,随访时间6~36个月,平均15.7个月;骨折均愈合,愈合时间10~14周。3例患者伤后出现坐骨神经损伤症状,均于术后6~12周恢复。股骨头骨折均获得复位,Matta影像学标准示髋臼解剖复位13例,满意复位3例,不满意复位2例,总体满意率88.9%(16/18)。术后2例患者发生异位骨化,均为BrookerⅠ级;无一例发生医源性血管损伤、股骨头缺血性坏死、感染、内固定物断裂等并发症。末次随访,根据Thompson-Epstein评价系统评价髋关节功能,其中优7例,良8例,可2例,差1例。结论DAA联合DPA入路治疗PipkinⅣ型股骨头骨折手术创伤相对较小,术中能直视下复位、固定股骨头及髋臼后部骨折,可有效保护旋股内侧动脉、坐骨神经、股外侧皮神经等重要结构,降低股骨头缺血性坏死、异位骨化等并发症的发生,术后临床疗效满意。     

改良髋关节前方入路治疗Pipkin Ⅰ、Ⅱ型股骨头骨折

目的 探讨应用改良髋关节前方入路治疗PipkinⅠ、Ⅱ型股骨头骨折的临床疗效.方法 回顾性分析应城市人民医院骨科自2012年2月至2015年2月应用改良髋关节前方入路治疗的12例股骨头骨折病人,其中PipkinⅠ型5例、Ⅱ型7例,收集记录手术时间、术中出血量等指标,以及病人骨折愈合、并发症发生情况,采用髋关节Harris评分对病人的功能恢复进行评价.结果 手术时间为52.0~85.5 min,平均为67.3 min;术中出血量为150.0~380.0 ml,平均为262.0 ml;住院时间为8~20 d,平均为13 d;随访时间为18~54个月,平均为24个月.所有病人骨折均一期愈合,愈合时间为12~17周,平均为15周,无股骨头坏死、伤口感染、深静脉血栓、异位骨化等并发症.其中1例PipkinⅡ型病人因骨折粉碎较重合并软骨面损伤出现一定程度的创伤性关节炎.根据髋关节Harris疗效评价标准,优9例,良2例,可1例,优良率为91.67%.结论 改良髋关节前方入路手术治疗股骨头骨折手术创伤小,对股骨头的血供破坏少,骨折愈合率高,并发症少,髋关节功能恢复良好,适用于PipkinⅠ、Ⅱ型股骨头骨折.     

一期人工全髋关节置换治疗中老年Pipkin Ⅳ型股骨头骨折

目的探讨一期人工全髋关节置换治疗中老年Pipkin Ⅳ型股骨头骨折的效果。方法对12例无坐骨神经损伤中老年Pipkin Ⅳ型股骨头骨折患者采用髋臼骨折复位钢板内固定、一期人工全髋关节置换术治疗。结果患者均获随访,时间12~36（22±3.8）个月。无假体松动、关节脱位及深部感染等并发症发生。根据Harris评分标准：优7例（94分±2.8分）,良5例（86分±2.3分）。结论采用髋臼骨折复位钢板内固定、一期人工全髋关节置换术治疗中老年Pipkin Ⅳ型股骨头骨折手术简单,临床效果显著。     

Middle-term follow-up results of Pipkin type IV femoral head fracture patients treated by reconstruction plate and bioabsorbable screws

Purpose

To investigate the mid-term curative effects of the treatment of Pipkin type IV femoral head fractures using a reconstruction plate and bioabsorbable screws and provide the evidence for clinical practice.

Hüftkopffrakturen

BACKGROUND: Dislocated fractures of the femoral head are highly infrequent injuries. In line with this multicenter study, a follow-up examination of patients with Pipkin fractures was performed in Austrian trauma centers. The aim of this study was to evaluate the types of fractures, the kind of treatment, and the long-term results. PATIENTS AND METHODS: In sum 46 patients were included in our study. A personal and radiological follow-up examination was carried out. The fractures were classified according to Pipkin. RESULTS: Patients with type I fractures had the best functional outcome according to the Harris Hip Score, followed by patients with type II fractures, type IV fractures, and finally type III fractures. The result of the radiological follow-up examination showed that patients who were treated conservatively or with extirpation of the fragment had a lower grade of arthrosis. The poorest radiological outcome was seen in patients who underwent surgical treatment with open reduction and internal fixation. The implantation of a total hip prosthesis was necessary in 24% of the patients. A relevant soft tissue calcification was not recorded. CONCLUSION: The size and location of the fractured fragment has a huge influence on the outcome. An exact anatomical reconstruction of the femoral head, especially of the weight-bearing part, is absolutely necessary.     

Late results after fracture of the femoral head

Summary The dislocation fracture of the femoral head is the result of high speed trauma. Most of the patients have additional injuries. The prognosis of this kind of fracture of the femoral head depends on the type of fracture, the additional injuries and the age of the patients. The diagnosis and the specific treatment are most important, since most of the patients with this injury are of a younger age. The reposition of the fracture has to be performed within 6 hours. In our opinion, this should be done by surgery if possible. For the operation some routine pelvic X-rays and a CT of the pelvis should be prepared. The therapy depends on the type of fracture. In patients with Type I and II fractures the broken head fragments should be refixed by only taking out small parts of bone which are not elementary for the pressure zone of the femoral head. Younger patients with Type III fractures should always receive the possibility of a screw fixation of the neck of femur, whereas total hip replacement should generally be achieved in the older patient. An exact reconstruction of the dorsal acetabulum must be performed in Pipkin Type IV fractures. The usual approach for Type I–III fractures is the ventrolateral Smith-Peterson and lateral Watson-Jones, for Type IV fractures, the dorsal Kocher-Langenbeck approach. We suggest indometacine as a prophylaxis for ossifications due to high tissue damage. Several scores for the evaluation and documentation of the outcome of this kind of fracture are useful: the clinical results according to Merle d'Aubigne, social status scored by the Karnofsky Index and X-ray results using Brooker and Helfet to classify the heterotopic ossification and post traumatic joint changes.      

Late results after fracture of the femoral head

The dislocation fracture of the femoral head is the result of high speed trauma. Most of the patients have additional injuries. The prognosis of this kind of fracture of the femoral head depends on the type of fracture, the additional injuries and the age of the patients. The diagnosis and the specific treatment are most important, since most of the patients with this injury are of a younger age. The reposition of the fracture has to be performed within 6 hours. In our opinion, this should be done by surgery if possible. For the operation some routine pelvic X-rays and a CT of the pelvis should be prepared. The therapy depends on the type of fracture. In patients with Type I and II fractures the broken head fragments should be refixed by only taking out small parts of bone which are not elementary for the pressure zone of the femoral head. Younger patients with Type III fractures should always receive the possibility of a screw fixation of the neck of femur, whereas total hip replacement should generally be achieved in the older patient. An exact reconstruction of the dorsal acetabulum must be performed in Pipkin Type IV fractures. The usual approach for Type I–III fractures is the ventrolateral Smith-Peterson and lateral Watson-Jones, for Type IV fractures, the dorsal Kocher-Langenbeck approach. We suggest indometacine as a prophylaxis for ossifications due to high tissue damage. Several scores for the evaluation and documentation of the outcome of this kind of fracture are useful: the clinical results according to Merle d'Aubigne, social status scored by the Karnofsky Index and X-ray results using Brooker and Helfet to classify the heterotopic ossification and post traumatic joint changes.     

Management and radiographic outcomes of femoral head fractures

Background

Femoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center.

Materials and methods

A retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis.

Results

We identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision.

Conclusions

Fractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon.

Level of evidence

IV—prognostic.

     

Proximal femoral locking plate with cannulated screws for the treatment of femoral neck fractures

The purpose of this study was to evaluate the efficacy and safety of the proximal femoral locking plate with cannulated screws for the treatment of femoral neck fractures. A prospective study was performed in 41 patients with femoral neck fractures treated with a proximal femoral locking plate with cannulated screws between January 2005 and December 2008. Twenty-five men and 16 women had a mean age of 47 years (range, 21-65 years). The time from injury to surgery ranged from 2 hours to 7 days. Three patients had a Garden type I fracture, 9 a type II, 18 a type III and 11 a type IV. Operative time, intraoperative blood loss, fracture healing time, Harris Hip Score for hip function, and complications were recorded to evaluate treatment effects.Mean operative time was 63.6 minutes (range, 40-90 minutes), with mean intraoperative blood loss of 84.2 mL (range, 50-200 mL). Mean time to union was 15.5 weeks (range, 12-36 weeks). Two patients (Garden type III and type IV) did not achieve union, and 4 patients (1 Garden type III and 3 type IV) had avascular necrosis of the femoral head. In patients with nonunion, 1 (Garden type III) underwent intertrochanteric osteotomy, and the other underwent total hip replacement (THR). In patients with avascular necrosis, 2 required THR and the others (1 Garden type III) required no further surgery. Twenty-six (63%) patients had excellent results, 8 (20%) had good results, 3 (7%) had moderate results, and 4 (10%) had poor results. These findings suggest that the proximal femoral locking plate with cannulated screws for the treatment of femoral neck fractures is effective and results in fewer complications, especially for Garden type I, II, and III fractures.     

Hip dislocation with femur head fracture

It is talked about the classification, the therapy and the late results of the traumatic dislocation of the hip joint with a fracture of the femoral head. Twelve patients with an average age of 36 years (from 18 to 77 years) were treated between the years 1972 and 1982. The rarer anterior dislocation of the hip including a fracture of the femoral head should be specifically classified, in order not to cause any errors for the therapeutic and prognostic assessment following the Pipkin classification. Type I and II with posterior dislocation justify a closed trial of reposition. The miscarried trial, and a continuing fragmental dislocation with a disturbance of the joint's function, or fragments participating in the load area of the femoral head necessitate an open reposition. Small fragments may be taken away, the larger ones require the screwing osteosynthesis. Smaller fragments from the load area must be sustained in an anterior dislocation ("IIb"). The type III injury gives primarily--in exceptional cases sometimes secondarily--an indication for an alloplastic false hip joint. Injuries of type IV should be restored operatively, respectively, it is necessary to perform a secondary operation to set in an endoprosthetic substitute. With the operative therapy--that is: 5 times extirpation of fragments, 4 times screwing osteosynthesis of the femoral head, twice screwing osteosynthesis of the acetabulum--we obtained good results in injuries of type I, II and IV. We performed 3 times a primary total false hip joint in type III injuries.     

Wenn die Hüfte nicht „nur“ luxiert

BACKGROUND: Traumatic hip dislocation combined with fracture of the femoral head is a rare condition for which little known in terms of long-term prognosis. The aim of the retrospective study presented here was to evaluate the clinical and radiological outcome of this specific injury. PATIENTS AND METHODS: In a 23 year period, 18 patients (17 male) with an average age of 25.6 (range 15-55 years) were treated. There were four type-I, three type-II, no type-III, and 11 type-IV fractures according to the Pipkin classification (1957). RESULTS: The average time to sufficient reduction was 136 min (60-420 min), two by open means. A total of 16 patients were operated for open reduction and internal fragment fixation, 13 through a dorsal approach. All patients filled out a standardized questionnaire, and clinical and radiological examinations were also carried out on average 12.6 years (range 59-247 months) after injury. Four scoring systems were used to classify the outcome: Thompson and Epstein (1951): very good = 1, good = 10, fair = 4, poor = 3; Merle D'Aubigne (1954): very good = 9, good = 5, fair = 0, poor = 4; Harris (1969): Pipkin I = 81 points, Pipkin II = 97 points, Pipkin IV = 73 points (mean); Brooker (1973): grade I = 5, grade II = 1, grade IV = 2. CONCLUSION: Quality of life was not reduced in most patients in the long term, however three of four patients suffering Pipkin type-IV fractures developed functional restrictions with poor results. We conclude that acute reduction of the dislocated joint and anatomical reconstruction of the femoral head instead of primary hip replacement may end in good to excellent results in type-I and type-II fractures. Due to the young age of these patients, joint reconstruction should always be the first choice even in type-IV fractures with a higher probability of poor prognosis.     

Pipkin骨折治疗的回顾性研究

目的 探讨髋关节后脱位伴股骨头骨折(Pipkin骨折)的治疗方法 及疗效.方法 回顾性分析2003年1月-2009年11月北京市顺义区医院收治的19例髋关节后脱位伴股骨头骨折的患者,其中Ⅰ型8例,Ⅱ型6例,Ⅲ型1例,Ⅳ型4例.其中17例根据病情分别应用切开复位内固定术治疗.结果 Ⅰ型8例,2例保守效果为良,手术优3例,...     

Femoral neck fracture complicating orthopedic reposition of a dislocated hip: four cases

Posterior dislocation of the femoral head with fracture is an exceptional hip injury. Emergency reduction is required. Reposition into the acetabular cavity of the dislocated femoral head may not be feasible. Irreducibility, instability, and more rarely accidental fracture of the femoral neck may also occur. We encountered this latter complication in four patients and report here its frequency and mechanism and propose preventive therapeutic measures. Seventy dislocations and fracture-dislocations of the hip were treated in our unit from March 1997 to February 2003. Among these cases, fourteen hip dislocations were complicated by femoral head fractures. Fracture of the femoral neck occurred during reduction in four. All four cases occurred in men, mean age 49.7 years, who were traffic accident victims (drivers or passengers). There were two Pipkin IV fracture-dislocations and two Pipkin II. The first reduction, achieved under general anesthesia in an emergency setting, was performed by an orthopedic surgeon in one patient and a general surgeon in three patients. Arthroplasty was used to treat the femoral neck fracture in three patients and pinning in one. We reviewed retrospectively the clinical and imaging data before and after reduction. Sub-capital fracture situated 4.0 cm (mean, range 3.5-4.5 cm) from the lesser trochanter occurred in all four cases. The head remained attached above and posteriorly to the acetabulum and was rotated less than 90 degrees . The fragment remaining in the acetabulum was displaced in two cases. In one patient, the fracture-dislocation of the head was associated with a fracture of the posterior rim of the acetabulum. This complication appears to result from an abrupt inappropriate reduction movement. The neck fracture would occur when capsulomuscular retention of the femoral head is associated with a head defect which catches on the rim of the acetabulum during the reduction movement. Neck fracture during reduction of traumatic hip dislocation is a serious complication. Prevention of this iatrogenic event requires a slow, progressive reduction limiting the trauma to a minimum; first intention open surgery may be required in selected cases.     

Mini-incision dynamic condylar screw fixation for comminuted subtrochanteric hip fractures

PURPOSE. To review the results of indirect reduction and mini-incision dynamic condylar screw (DCS) fixation for comminuted subtrochanteric femoral fractures. METHODS. 29 men and 14 women aged 25 to 65 (mean, 44) years with comminuted subtrochanteric femoral fractures underwent indirect reduction and mini-incision DCS fixation. Fractures were classified according to the AO classification (10 type 32B and 33 type 32C) and Seinsheimer classification (6 type III, 15 type IV, and 22 type V). Functional outcomes were assessed using the Harris hip score and Merle d'Aubigne score. RESULTS. The mean time to full weight bearing was 11 (range, 8-19) weeks. The mean time to union was 16 (range, 13-22) weeks. There were no cases of non-union or implant failure after a mean follow-up period of 25 (range, 18-30) months. Seven patients had a mean limb length discrepancy of 1.5 (range, 1-2) cm. Two patients had coxa vara and persistent limp. According to the Harris hip score, functional results were excellent in 12 and good in 31 patients. The mean Harris hip score was 88 (range, 80-99) and the mean Merle d'Aubigne score was 17 (range, 14-18). There was no deep infection or avascular necrosis of the femoral head. Restriction of knee flexion beyond 90 degrees was noted in 2 patients. CONCLUSION. Results of indirect reduction and mini-incision DCS fixation for comminuted subtrochanteric femoral fractures are favourable. Proper planning and execution of the technique is required to achieve good functional outcomes and avoid complications. Preservation of vascularity of the medial fragments leads to rapid callus formation and early union and hence avoids implant failure and secondary bone grafting.     

Operative treatment of displaced Pipkin type I and II femoral head fractures

Background and purpose

The optimal surgical approach for the treatment of femoral head fracture remains controversial. We retrospectively reviewed patients with Pipkin type I and II femoral head fractures managed surgically through posterior Kocher–Langenbeck approach and Ganz trochanteric flip approach aiming to define the best approach with the least morbidity.

Patients and methods

Between May 1995 and November 2010, 23 patients (14 men and 9 women) with an average age of 39.1 years (range 27–62) were treated by open reduction and internal fixation of femoral head fractures (5, Pipkin type I; and 18, type II) through Kocher–Langenbeck approach in 11 patients and trochanteric flip (digastric) osteotomy in 12. The two approaches were compared regarding operative time, difficulty of reduction and fixation, amount of blood loss, occurrence of femoral head osteonecrosis or heterotopic ossification and the final functional outcome. The scale of Brooker was used to document heterotopic ossification. The modified Merle d’Aubigne and Postel as well as Thompson and Epstein scores were used for final evaluation.

Results

Trochanteric flip approach was associated with less operative time, less blood loss and improved visualization facilitating direct screw fixation compared with Kocher–Langenbeck approach. Non-union of the trochanteric osteotomy developed in one patient. Heterotopic ossification was seen more in trochanteric flip-approached cases. Avascular necrosis of the femoral head occurred in one patient (8.1 %) of trochanteric flip-approached group and two (18.1 %) of posterior approach group. All patients were followed up for an average of 31 months (range 24–84). Except for one patient, the final outcomes were equal in the two groups.

Conclusions

Despite the limited number of patients, we can conclude that good final outcome does not necessarily follow a specific approach.     

Pipkin骨折术后髋关节功能恢复影响因素分析

目的探讨影响Pipkin骨折术后髋关节功能恢复的因素。方法回顾分析2002年5月-2009年2月收治的37例Pipkin骨折患者临床资料。男32例,女5例;年龄26～98岁,中位年龄43岁。致伤原因:交通事故伤31例,摔伤4例,高处坠落伤2例。受伤至手术时间1～28 d,平均8.6 d。骨折根据Pipkin分型标准:Ⅱ型23例,Ⅲ型8例,Ⅳ型6例。27例采用切开复位内固定(open reduction and internal fixation,ORIF),10例行人工全髋关节置换(totalhip arthroplasty,THA)。对性别、年龄、受伤至手术时间、骨折类型、治疗方式与术后髋关节功能恢复相关关系进行统计学分析。结果术后患者切口均Ⅰ期愈合,无感染及下肢深静脉血栓形成发生。患者均获随访,随访时间10～94个月,平均40.5个月。X线片复查ORIF患者骨折于术后5～11个月达骨性愈合,平均8.9个月;THA患者无假体松动、下沉。末次随访时牛津髋关节评分标准(OHS)评分为16～58分,平均37.2分;获优12例,良13例,可2例,差10例。单因素分析表明,骨折类型及治疗方式对术后髋关节功能恢复有显著影响,差异有统计学意义(P<0.05)。多因素分析表明,骨折类型及治疗方式对术后髋关节功能恢复影响无统计学意义(P>0.05)。结论 Pipkin骨折分型及治疗方式可能影响Pipkin骨折术后髋关节功能恢复,术前应根据骨折分型选择恰当治疗方式以保证关节功能恢复。