髋关节后脱位合并股骨头骨折及坐骨神经损伤的治疗

目的探讨髋关节后脱住合并股骨头骨折及坐骨神经损伤的治疗方法及效果。方法对6例髋关节后脱住合并股骨头骨折及坐骨神经损伤的患者，按照Pipkin分型：I型4例，Ⅱ型1例，Ⅳ型1例；髋关节脱住全部急诊6小时内闭合复位，股骨头骨折后侧入路可吸收螺钉固定，对于损伤的坐骨神经行神经探查修复术，l例Ⅳ型髋臼后壁骨折的应用重建钢板固定。结果所有病例随访6～32个月（平均24个月）。骨折均愈合，愈合时间为12～21周，平均16周；随访期内未见股骨头坏死出现，髋关节评分按照Epstein标准：优5例，良1例。神经恢复按照MCRR标准：优4例，良1例，一般1例。结论髋关节后脱住并股骨头骨折及坐骨神经损伤应急诊超早期行髋关节复位，早期明确诊断及选择合适入路内固定，早期探查松解坐骨神经对其恢复有重要意义。

Treatment for posterior dislocation of hip joint combined with fracture of femoral head and the sciatic nerve injuries

Objective To approach the results of surgical treatment of posterior dislocation of hip joint combined with fracture of femoral head and the sciatic nerve injuries. Method 6 patients were treated surgically for posterior dislo- cation of hip joint combined with fracture of femoral head and the sciatic nerve injuries from September 2005 to May 2008, according to Pipkin＇s classification, there were type I in 4 cases, typeⅡ in 1 case, type Ⅳ in 1 case. All posterior dislocation of hip joint were closed reduced within 6 hours and the cases were reduced and fixed with absorbable screw, operated with neurolysis. Results All cases were followed up,the following-up period lasted from 6-32months with an average of 24 months. Fracture healed successfully in 6 cases, the average time of fracture healing was 16 weeks （ range from 12-21 weeks）. According to Epstein criteria：5 cases were excellent, 1 case was good; According to MCRR criteria： 4 cases were excellent, 1 cases was good and 1 case was fair. Conclusion Super-early reduction of joint, early diagnosis and proper treatment （open-reduction and fixation, neurolysis） can contribute to better prognosis of posterior dislocation of hip joint combined with fracture of femoral head and the sciatic nerve injuries.