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髋关节后脱位伴股骨头骨折:分型与修复方式的影响
引用本文:谭章勇,汪建良,郭峰,刘卫峰,许科峰.髋关节后脱位伴股骨头骨折:分型与修复方式的影响[J].中国临床康复,2014(13):1975-1980.
作者姓名:谭章勇  汪建良  郭峰  刘卫峰  许科峰
作者单位:解放军第101医院骨科,江苏省无锡市214044
摘    要:背景:髋关节后脱位伴股骨头骨折易导致股骨头坏死、异位骨化、骨性关节炎、深静脉血栓等一系列并发症,应根据不同骨折类型针对性地采用不同的治疗方法。 目的:探讨影响髋关节后脱位伴股骨头骨折疗效及并发症的各种因素。 方法:解放军第101医院自2004年9月至2010年5月共收治28例髋关节后脱位伴股骨头骨折患者,按股骨头骨折Pipkin分型、不同手术入路及受伤至手术治疗时间分组,以X射线平片及髋关节功能恢复情况(Epstein法)评估疗效,并记录并发症发生情况。 结果与结论:28例获得随访,随访时间平均2.8年(1-5年)。根据Epstein法评估疗效,优6例,良12例,可7例,差3例,优良率达64%。其中PipkinⅠ、Ⅱ型患者治疗效果较好(优良率100%,78%),并发症发生也不多(发生率17%,22%),但 Pipkin Ⅲ、Ⅳ型患者治疗效果不佳,尤其是 Pipkin Ⅳ型患者治疗后的优良率仅20%,且并发症发生率达80%。采用Smith-Peterson前方入路患者及K-L后方入路患者并发症发生率比较差异无显著性意义(P〉0.05)。股骨头骨折至手术的时间48 h的3组患者并发症发生率比较差异无显著性意义(P〉0.05)。结果提示,股骨头骨折应根据分型选择治疗方法,其预后取决于患者的年龄、治疗时间、骨折脱位类型、治疗方法以及预防并发症的相关措施。

关 键 词:植入物  人工假体  关节植入物  髋关节后脱位  股骨头骨折  Pipkin分型  疗效  并发症  手术入路

Posterior hip dislocation combined with femoral head fractures:effects of typing and repair methods
Tan Zhang-yong,Wang Jian-liang,Guo Feng,Liu Wei-feng,Xu Ke-feng.Posterior hip dislocation combined with femoral head fractures:effects of typing and repair methods[J].Chinese Journal of Clinical Rehabilitation,2014(13):1975-1980.
Authors:Tan Zhang-yong  Wang Jian-liang  Guo Feng  Liu Wei-feng  Xu Ke-feng
Institution:(Department of Orthopedics, the 101 Hospital of Chinese PLA, Wuxi 214044, Jiangsu Province, China)
Abstract:BACKGROUND:Posterior hip dislocation combined with femoral head fractures easily induced femoral head necrosis, ectopic ossification, osteoarthritis and deep vein thrombosis. Different therapeutic methods should be utilized according to the type of fracture. OBJECTIVE:To investigate the factors affecting the therapeutic effects and complications fol owing surgery of posterior hip dislocation combined with femoral head fractures. METHODS:Twenty-eight patients, who had been diagnosed as posterior hip dislocation combined with femoral head fractures in the 101 Hospital of Chinese PLA from September 2004 to May 2010, were enrol ed in this study. According to Pipkin typing, operative approach and the time from injury to surgery, therapeutic effects were evaluated using radiographs and the recovery conditions of hip function (Epstein method), and the occurrence of complications was recorded. RESULTS AND CONCLUSION:A total of 28 patients were fol owed up from 1 to 5 years, averagely 2.8 years. Using the Epstein method, there were excellent in 6 cases, good in 12 cases, average in 7 cases, and poor in 3 cases, with an excellent and good rate of 64%. The therapeutic effects in patients with Pipkin I and II were good, with excellent and good rates of 100%and 78%, respectively. Moreover, the complications were less, with a rate of 17%and 22%, respectively. The therapeutic effects of patients with Pipkin III and IV were poor, especial y, Pipkin IV patients, whose excellent and good rate was only 20%and the incidence of complications was 80%. No significant difference in the incidence of complications was detected in patients undergoing Smith-Peterson anterior approach and K-L posterior approach (P〉0.05). No significant difference in the incidence of complications was detectable among patients from three groups (the time from fracture to operation48 hours) (P〉0.05). Results indicated that the choice of treatment method should be determined by the type of fracture. The prognosis depends on the patient’s age, time of treatment, types of fracture and dislocation, methods of treatment and related measures of prevention of complications.
Keywords:femoral fractures  femur head  hip dislocation  treatment outcome  postoperative complications
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