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.

Surgical treatment and prognosis of acetabular fractures associated with ipsilateral femoral neck fracture

Objective To discuss the efficacy of open reduction and internal fixation in the treatment of acetabular fractures associated with ipsilateral femoral neck fracture.Methods From October 1990 to January 2008,5 male and 2 female cases of acetabular fractures associated with ipsilateral femoral neck fractures were treated with open reduction and internal fixation.Their mean age was 38 years.According to the Letournel classification,fractures involved posterior acetabular wall in 2 cases,posterior column plus posterior wall in 1,transverse acetabulum plus posterior wall in 2 and both columns in 2.According to the Garden classification,2 patients had type Ⅲ fracture and 5 type Ⅳ.Both X-ray films and CT scans showed 5 cases were associated with femoral head dislocation.Results All the 7 patients were followed up for 1 to 18 years (average,9 years).Postoperative X-ray films showed anatomic reduction of acetabular fracture in 5 cases and satisfactory reduction in 2 cases,as well as satisfactory reduction of femoral neck fracture in all the patients.Postoperative X-ray films also revealed necrosis of femoral head in the 5 patients who had femoral neck fractures and femoral head dislocation,but not in the other 2 who had no femoral head dislocation.Conclusions Total hip replacement should be the treatment of choice for patients who are complicated with femoral neck fracture and femoral head dislocation,because the rate of necrosis of femoral head is very high.For patients who have no femoral head dislocation,however,open reduction and internal fixation is the best choice for primary treatment.