髋关节后脱位合并股骨头骨折的手术治疗

[目的]探讨髋关节后脱位合并股骨头骨折的手术治疗方法与效果。[方法]1997年7月～2005年10月,共收治17例髋关节后脱位合并股骨头骨折病例,采用可吸收螺钉固定股骨头骨折12例,钛螺钉固定2例,3例骨片较小无法固定给予摘除。应用重建钢板固定髋臼骨折3例。[结果]所有患者获1～7年随访,骨折均愈合,无感染。采用Epstein标准进行功能评定,优6例,良7例,可3例,差1例,优良率达76.5%。[结论]髋关节后脱位合并股骨头骨折根据分型选择手术治疗方法,手术入路应综合多方面因素进行选择,可吸收螺钉是较理想的内固定物,术后应早活动,晚负重。     

可吸收螺钉治疗股骨头骨折伴髋关节后脱位

目的探讨应用可吸收螺钉治疗股骨头骨折伴髋关节后脱位的效果。方法髋后外侧入路手术治疗26例股骨头骨折伴髋关节后脱位患者,股骨头骨折均采用可吸收螺钉固定;Ⅲ型合并股骨颈骨折者采用钛质空心螺钉固定,Ⅳ型合并髋臼骨折者采用髋臼三维记忆内固定系统固定髋臼骨折。结果26例均获随访,时间15～48个月。按D′Aubigue-Postel评分法：优10例,良13例,中1例,差2例（1例股骨头缺血性坏死,1例股骨头缺血性坏死合并髋周异位骨化）。未出现可吸收螺钉断裂及异物反应现象,无深部感染及创伤性关节炎等并发症发生。结论股骨头骨折伴髋关节后脱位采用髋后外侧入路、可吸收螺钉及髋臼三维记忆内固定可获得理想的治疗效果。     

髋关节后脱位合并股骨头骨折的手术治疗

目的 探讨髋关节后脱位合并股骨头骨折的手术治疗方法与效果.方法 收治9例髋关节后脱位合并股骨头骨折病例,采用可吸收螺钉固定股骨头骨折5例,钛螺钉固定2例2例骨片较小无法固定给予摘除,合并应用重建钢板固定髋臼骨折1例.结果 9例骨折均愈合,未发生股骨头坏死及髋关节骨性关节炎.采用Epstein标准进行功能评定,优4例,良3例,可2例,优良率达77.8%.结论 髋关节后脱位合并股骨头骨折应根据分型选择手术方法,手术入路根据具体病例进行选择,可吸收螺钉是较理想的内固定物.     

髋臼骨折合并同侧股骨颈骨折的手术治疗

目的：探讨髋臼骨折合并同侧股骨颈骨折的治疗方法及其疗效。方法2005年1月至2010年1月,本院收治5例髋日骨折合并同侧股骨颈骨折患者,4例男性,1例女性,平均年龄38岁。所有患者均先试闭合复位内固定股骨颈,闭合复位失败再根据髋臼骨折类型采用前路或后路或联合人路先复位固定股骨颈骨折再复位固定髋臼骨折。术后按照Matta标准和Haidukewych标准分别评价髋臼复位和股骨颈复位。结果术后随访18．74个月,平均35个月。髋臼骨折4例解剖复位,1例满意复位;股骨颈骨折均复位优,所有患者均骨折愈合。2例患者伴脱位,进行延期切开复位内固定,术后患者出现股骨头坏死,行全髋置换,术后患者对功能满意,余3例患者未出现股骨头坏死,对术后功能满意。结论髋臼骨折合并同侧股骨颈骨折采用切开复位内固定可以恢复髋关节良好功能,髋臼的解剖复位对术后髋关节功能起很大作用。     

可吸收钉棒内固定治疗股骨头、髋臼骨折

目的 应用可吸收钉棒(SR—PLLA)内固定治疗10例股骨头骨折、髋臼骨折的疗效。方法 本组病例中，4例股骨头骨折，4例髋臼后缘骨折，两者合并存在2例，术前9例合并髋关节后脱位，1例合并骶髂关节开放性脱位。均经髋关节后外侧或后路切开复位可吸收螺钉及固定棒固定，术后持续骨牵引6周，并主动下肢屈髋活动。结果 随访平均14．5个月，按髋关节功能评定标准：优6例，良3例，可1例，术后一年发生股骨头缺血性坏死1例．无感染、骨折移位、关节僵硬等并发症发生。结论 SR—PLLA内固定是治疗股骨头骨折、髋臼骨折的理想方法。     

髋关节后脱位并髋臼后壁（柱）骨折手术治疗结果分析

目的探讨髋臼后壁（柱）骨折伴髋关节脱位手术治疗的中远期疗效。方法回顾性分析21例髋关节脱位伴髋臼骨折患者临床资料,其中20例髋臼脱位行闭合复位,1例行急诊切开复位内固定;所有合并的髋臼骨折均采用开放复位内固定术治疗。结果完整随访19例,失访2例,随访时间29～86个月。按髋关节功能恢复情况评分：优13例,良3例,可2例,差1例,优良率84．2％。结论髋关节脱位伴髋臼骨折应尽早诊断,应尽快行髋关节复位,骨折应尽早开放复位内固定,早期功能锻炼,避免过早负重。     

外伤性髋关节骨折脱位18例治疗体会

髋关节骨折脱位是指股骨头后脱位合并髋臼骨折或 /和股骨头骨折。我院自 1989年 7月～ 1998年 7月治疗 18例髋关节骨折脱位 ,治疗效果满意 ,报告如下。1　临床资料本组 18例 ,男 16例 ,女 2例 ;年龄 2 1～ 5 6岁 ,平均 3 8 5岁。本组 18例均为受伤后 3周内手术 ,均为新鲜脱位合并骨折。 17例因车祸致伤 ,1例为高处坠落伤。2　治疗方法18例患者在无禁忌症情况下 ,全部在腰麻下进行手法复位。对复位成功不需手术者 ,进行皮牵引或骨牵引 4～ 6周 ,本组 6例。手法复位失败 2例和 10例股骨头虽然复位 ,但合并髋臼或股骨头骨折均手术治疗 ,行髋关…     

髋臼合并同侧股骨颈骨折的手术治疗与预后

目的 探讨髋臼合并同侧股骨颈骨折的手术方法与预后.方法 1990年10月至2008年1月共收治7例髋臼合并同侧股骨颈骨折患者,其中男5例,女2例;年龄22～55岁(平均38.6岁).髋臼骨折按Letournel分类:后壁骨折2例,后柱伴后壁骨折1例,横行伴后壁骨折2例,双柱骨折2例.股骨颈骨折按Garden分型:Ⅲ型2例,Ⅳ型5例.其中X线片和CT片示股骨颈骨折合并股骨头游离脱位于髋臼后上方者5例,仅显示股骨颈骨折而无脱位者2例.结果切开复位内固定术后X线片示5例移位髋臼骨折患者获解剖复位,2例获满意复位.股骨颈骨折均获满意复位和固定.7例患者术后获1～18年(平均8.6年)随访,X线片示5例合并股骨头脱位者日后均出现股骨头缺血性坏死,坏死率高达100%(5/5),髋关节功能恢复均为差,于内固定术后2～4年改行全髋关节置换术.而2例股骨头未脱位者至今X线片上仍未显示任何股骨头坏死迹象,也无创伤后关节炎表现,髋关节功能恢复均为优.结论 髋臼合并同侧股骨颈骨折患者,如同时合并股骨头脱位,因股骨头坏死率高,应首选全髋关节置换术治疗.如未合并股骨头脱位,可以考虑首选切开复位内固定.     

可吸收钉棒内固定治疗股骨头、髋臼骨折

目的 应用可吸收钉棒(SR-PLLA)内固定治疗10例股骨头骨折、髋臼骨折的疗效。方法 本组病例中,4例股骨头骨折,4例髋臼后缘骨折,两者合并存在2例,术前9例合并髋关节后脱位,1例合并骶骼关节开放性脱位。均经髋关节后外侧或后路切开复位可吸收螺钉及固定棒固定,术后持续骨牵引6周,并主动下肢屈髋活动。结果 随访平均14.5个月,按髋关节功能评定标准:优6例,良3例,可1例,术后一年发生股骨头缺血性坏死1例,无感染、骨折移位、关节僵硬等并发症发生。结论 SR-PLLA内固定是治疗股骨头骨折、髋臼骨折的理想方法。     

髋关节中心骨折脱位合并Morel-Lavallée损伤的手术治疗策略

目的探讨髋关节中心骨折脱位合并Morel-Lavallée损伤的手术治疗方法及疗效。方法回顾性分析自2010-06—2016-10采用单纯负压吸引联合内固定一期手术治疗的5例髋关节中心骨折脱位合并Morel-Lavallée损伤,髋臼粉碎性骨折行切开复位内固定,治疗后期均出现不同程度皮肤坏死,创面清创后间断缝合或游离植皮修复。结果 5例均获得随访,随访时间平均7.8(4~16)个月。Morel-Lavallée损伤均于术后32~50 d痊愈,平均40 d。创面均愈合,无深部感染发生。髋臼骨折骨性愈合良好,X线片显示骨折均于术后6个月愈合。末次随访时髋关节功能Harris评分:良1例,可4例。结论对于髋关节中心骨折脱位合并Morel-Lavallée损伤,单纯引流管负压吸引治疗Morel-Lavallée损伤可确保一期切开复位股骨头脱位并髋臼骨折内固定的手术时机和切口安全,但患者术后髋关节功能严重受损,致残率高。     

髋关节后脱位合并股骨头骨折的诊疗方法

目的 总结髋关节后脱位合并股骨头骨折１２例的诊治情况。方法 根据股骨头骨折Ｘ线片及ＣＴ所见采取单纯牵引７例,手术治疗５例,包括关节内游离骨片摘除１例,髋关节碎骨片清理,髋臼骨折复位内固定２例,行股骨头骨折切开复位可吸收螺丝钉内固定术２例。术后早期开始被动及主动髋关节功能锻炼。结果 经过６个月￣３年随访,髋关节功能优良率达９１．６％。结论 对髋脱位复位后股骨头骨折对位良好及关节腔外非负重区游离骨片者无需手术治疗,同时注意关节早期功能锻炼,以利关节磨造及软骨修复。     

手术治疗髋臼后壁骨折45例

目的：探讨应用重建钢板内固定治疗髋臼后壁骨折的临床疗效。方法：对45例经手术复位重建钢板内固定治疗的髋臼后壁骨折进行回顾性分析,男31例,女14例;年龄19～68岁,平均37.6岁。合并髋关节脱位者41例。全部后侧Kocher-Langenbeck切口。结果：45例均获随访,随访时间为12～48个月,平均26个月。按Matta的X线复位标准和Matta改良的d＇Aubigne临床标准评估,解剖复位38例,满意复位7例;临床结果优30例,良10例,一般5例,优良率为88.9%。本组中发生创伤性关节炎4例,股骨头坏死2例,异位骨化2例,下肢深静脉血栓1例,无切口感染和骨不愈合。结论：重建钢板内固定治疗髋臼后壁骨折可获得满意的临床疗效。骨折复位质量、伤后至手术时间、骨折粉碎程度、手术经验是影响髋臼后壁骨折治疗效果的关键。     

股骨干顺行髓内钉固定后同侧股骨颈骨折的治疗

目的：探讨股骨干骨折行顺行髓内钉固定后发现同侧股骨颈骨折的治疗方法。方法：回顾性分析2000年1月至2010年1月股骨干骨折行顺行髓内钉固定后术中或术后发现同侧股骨颈骨折的患者12例,全部以2枚螺钉分别自髓内钉前后方固定股骨颈骨折,定期随访,评估骨折愈合及功能恢复情况。结果：术后随访10—36个月,平均16．5个月。股骨颈骨折平均愈合时间3．6个月,股骨干骨折平均愈合时间5．4个月,无股骨头坏死发生。按Harris评分标准髋关节功能：优7例,良3例,可2例。结论：股骨干骨折顺行髓内钉固定后发现同侧股骨颈骨折,以2枚螺钉分别自髓内钉前后方固定股骨颈骨折方法可行,固定可靠,手术创伤小,骨折愈合率高。     

膝关节强直股四头肌成形术后的处理

我院自 1993年～ 1997年来 ,收治膝关节僵硬强直 9例 ,取得满意疗效。现报告如下。1　临床资料　　本组 9例中男 4例 ,女 5例 ;年龄 2 2～ 45岁 ;左侧 3膝 ,右侧 6膝。均骨折 6月至 1年后骨折愈合、膝关节强直 ;股骨干骨折小夹板外固定加胫骨结节骨牵引1例、股骨髁骨折“Ｌ”型钢板螺丝钉内固定 2例 ,螺柱螺钉内固定 1例 ,髌骨骨折钢丝内固定 1例 ,伸直位石膏托外固定2例 ,胫骨平台跟骨牵引 2例。以上 9例膝关节功能为 0°～ 5°～ 10°。2　治疗方法　　采用连续硬膜外麻醉 ,大腿根部空气止血带 ,常规消毒铺巾 ,取股前正中纵形切口 ,行股四…     

The Role of Surgical Hip Dislocation in the Treatment of Acetabular and Femoral Head Fractures

Abstract Background and Purpose: Surgical hip dislocation by trochanteric flip osteotomy facilitates access to acetabular and femoral head fractures. Furthermore, it allows evaluation of cartilage damage and vascularity of the femoral head. In this study the potential benefits of this procedure for improved fracture management and for prognostic assessment were investigated. Patients and Methods: From July 1997 to October 1999, 20 selected patients with displaced acetabular fractures (n = 12), femoral head fractures (n = 7), or combined injuries (n = 1) were included. Inclusion criteria for acetabular fractures were either displaced posterior wall fragments with cranial extension or complex acetabular fractures involving a displaced transverse fracture line. Open reduction and fixation of either complex acetabular fractures or femoral head fractures were carried out through Kocher-Langenbeck approach, trochanteric flip osteotomy, and complete surgical hip dislocation. Additionally, the extent of cartilage destruction and femoral head perfusion were assessed. Results: Anatomic reduction ( 1 mm displacement) of acetabular fractures was achieved in 69% of patients and good reduction ( 3 mm) in 31%. In patients with acetabular fractures, severe cartilage destruction of the acetabulum was found in 38% and of the femoral head in 15%, while patients with isolated femoral head fractures revealed severe cartilage damage of the femoral head in 57%. Arterial bleeding from the femoral head, tested by drilling, was observed in all patients. Secondary dislocation of the trochanteric osteotomy occurred in one patient and made refixation necessary. Patients were reexamined at least 2 years after intervention. 77% of patients with acetabular fractures and all patients with femoral head fractures showed good or excellent results after 32.6 ± 6.1 months according to the functional score of DAubigné & Postel. Conclusion: Surgical hip dislocation allows adequate reconstruction of complex acetabular and femoral head fractures and intraoperative evaluation of local cartilage damage and femoral head perfusion.     

The natural history of bone bruise and bone remodelling in the traumatised hip: A prospective 2-year follow-up study of bone bruise changes and DEXA measurements in 13 patients with conservatively treated traumatic hip dislocations and/or fractures

IntroductionThe purpose of this study was to assess the natural history of bone bruise and bone mineral density (BMD) after traumatic hip dislocations and conservatively treated acetabular fractures. Our hypothesis was that poor bone quality can influence degree of bone bruise and, in time, cause degenerative changes.Materials and methodsEight consecutive patients with traumatic hip dislocations and five patients with conservatively treated fractures in the femoral head and/or acetabulum were included. Magnetic resonance imaging (MRI) was obtained after 1, 17, 42, 82 and 97 weeks. Dual-emission X-ray absorptiometry (DXA) measurements were made after 10 days and 2 years. Sizes of bone bruise lesions were measured and classified. At the 2-year follow-up, Harris hip score (HHS) was calculated and signs of radiological osteoarthritis (OA) registered.ResultsThe bone bruise changes were small and all changes resolved within 42 weeks in all, except for three patients; one with a small Pipkin fracture had segmental avascular necrosis (AVN) of the femoral head, one had persisting1–3 mm small spots of bone bruises in the femoral head and the third had <1 cm lesions in both the femoral head and the acetabulum. The lesions were bigger in the femoral head in the hip dislocations and more pronounced in the acetabulum in the fractured acetabuli. We found no significant changes in BMD in four regions of interest (ROIs) after 2 years. No patients developed OA, and all had excellent HHS except for the one patient with AVN.ConclusionThe post-traumatic bone bruise changes in the dislocated hips and the fractured acetabuli were small and transient compared to findings of other authors examining traumatised knees. The patients had excellent function and no OA after 2 years if they did not develop AVN. In our small sample of relatively young patients with normal age-adjusted BMD, no post-traumatic osteopenia was observed. This might differ in the elderly with poorer bone quality; further studies are needed to assess that.     

Dislocated intra-articular femoral head fracture associated with fracture-dislocation of the hip and acetabulum: report of 12 cases and technical notes on surgical intervention

This report describes case series of the femoral head fractures associated with fracture-dislocation of the hip joint to evaluate the mid- and long-term outcomes and to highlight the surgical technique of fixation of the femoral head from the posterior trochanteric flip osteotomy approach. Twelve patients (6 men and 6 women) with dislocated femoral head fractures (mean age at the time of injury, 56 years; range, 23–80) were followed up for mean period of 9.7 years (range, 5–20). All dislocations were reduced within less than 6 h after the injury. The type of femoral head fracture was classified according to the Pipkin classification on radiographs and CT. Five patients were classified as type I, 2 as type II, 2 as type III, and 3 as type IV. The clinical and radiological outcomes were assessed by Thompson and Epstein’s regimen. Excluding 2 patients with Pipkin type III, the outcome of 9 patients was excellent/good, and poor in 1. The latter patient sustained Pipkin type IV and developed osteoarthritis 1 year after surgery and consequently required total hip arthroplasty. We conclude that small fragment of the femoral head less than 1 cm can be removed, while larger fragments should be fixed by bioabsorbable screws or pins in all types of femoral head fractures. In Pipkin type IV fractures, surgeons should always take anatomical reduction in the acetabulum into consideration during surgery.     

髋臼后壁边缘压缩骨折伴髋关节后脱位的诊治

目的探讨髋臼后壁边缘压缩骨折伴髋关节后脱位的诊断与治疗。方法2000年2月- 2005年10月,对11例涉及髋臼后壁边缘压缩骨折伴髋关节后脱位患者进行回顾性总结,所有患者的后壁边缘压缩骨折、髋关节后脱位均由CT扫描得到证实。患者均采用手术切开复位,对边缘压缩骨折进行撬起和植骨,重建钢板螺丝钉内固定术。结果所有患者获得平均5-56个月(32．4个月)随访,临床结果采用改良d'Aubigne和Postel髋关节评分标准:优4例,良4例,可2例,差1例,优良率为72．7％。1例原发坐骨神经损伤,系骨折块压挫伤,于术后2个月完全恢复。1例因术中未严格保持伸髋屈膝位导致坐骨神经牵拉伤,4个月后基本恢复。1例异位骨化,为BookerⅡ型。1例复位欠佳者出现创伤性关节炎,关节间隙变窄。结论髋臼后壁边缘骨折伴髋关节后脱位患者容易发生边缘压缩性骨折,术前CT扫描可明确诊断,术中要对边缘压缩骨折部分撬起和充分植骨,提高股骨头与髋臼解剖对应率,可取得较好疗效。     

股骨颈骨折内固定失败Ⅱ期行髋关节置换的早期疗效

目的:研究青壮年股骨颈骨折患者内固定失败后Ⅱ期行髋关节置换的早期临床疗效。方法:2008年6月至2010年6月,对24例股骨颈骨折内固定术后股骨头坏死患者行全髋关节置换术,其中男12例,女12例;年龄18～58岁,平均42.9岁。术后行X线检查,并根据Harris评分标准评价临床疗效。结果:23例获得随访,平均随访时间34.4个月(25～48个月),1例术后并发髋关节脱位,未发现髋关节感染、松动或假体周围骨折等并发症。Harris评分为90.9±4.3,优18例,良4例,可1例。结论:Ⅱ期全髋关节置换治疗股骨颈骨折内固定术后并发股骨头坏死,术中手术难度增加,但可以获得良好的早期疗效。