陈旧性移位髋臼横行骨折的外科治疗

目的 :探讨陈旧性移位髋臼横行骨折的诊断、分类及外科治疗的特点。方法 :采用回顾性研究方法对手术治疗的陈旧性移位髋臼横行骨折的病例进行总结分析。结果 :8例陈旧性移位髋臼横行骨折 ,6例为简单骨折 ,2例为复杂性骨折 ,合并股骨头中心型脱位 3例。 5例采用改良扩大的髂股入路骨折切开复位钢板螺丝钉内固定术 ,3例采用取带缝匠肌髂骨骨瓣植骨术。术后解剖复位 4例 ,满意复位 4例。结论 :陈旧性髋臼横行骨折延期手术易导致失败的因素较多 ,髋臼窝直视下骨折复位可确保髋臼内壁的光滑。对于小于 3mm陈旧性的髋臼横行骨折 ,采用带肌蒂髂骨骨瓣植骨可起到加速骨折愈合的目的     

难复的髋关节中心性脱位骨折手术治疗商榷

报告22例难复的髋关节中心脱位骨折,11例随访4年9个月,发生股骨头缺血环死或创伤性关节炎81.8%.作者在手术中观察到髋白骨折的移位、股骨头对髋臼的压迫作用和骨折、微骨折,提出髋关节中心性脱位骨折的分类方法.采用外固定架稳定头臼复位,髋臼骨折复位后植骨和钢板固定,术后六周用CPM良好的主被动功能训练,是取得良好疗效的重要条件.     

难复的髋关节中心性脱位骨折手术治疗商榷

报告２２例难复的髋关节中心脱位骨折，１１例随访４年９个月，发生股骨头缺血坏死或创伤性关节炎８１．８％，作者在手术观察到髋白骨折的移位，股骨头对髋臼的压迫作用和骨折，微骨折，提出髋关节中心性脱位骨折的分类方法，采用外固定架稳定头臼复位，髋臼骨折复位后植骨和钢板固定，术后六周用ＣＰＭ良好的主被动功能训练，是取得良好疗效的重要条件。     

髋关节中心型脱位复位致股骨头骺分离1例

患者,男,12岁,学生。5h前因跌伤右髋部,致右髋部肿胀、疼痛、活动受限入院。查体:右髋部皮肤青紫、肿胀、触痛明显。右股骨大粗隆触摸不清,右髋关节主动及被动活动受限,右下肢较左下肢短缩3cm。余未见异常。X线片示右髋关节中心型脱位,右坐骨支及左耻骨支骨折。 治疗 入院后局麻下行手法复位,复位后床头透视发现股骨头骺分离。股骨头滞留于盆腔内,急诊行切开复位内固定,带缝匠肌骨瓣植骨术,术中见右髋臼底粉碎骨折,破口可容三横指,髋臼前缘破裂,股骨头位于盆腔内约2cm。用布巾钳自破口取出股骨头,髋臼底部整复未作固定,复位后三根克氏针交叉固定,切取缝匠肌蒂的髂骨瓣约3cm×2cm×2cm。于股骨头下开骨槽,填塞骨瓣,缝合骨膜,术后持续皮牵引3个月,床上活动。术后8个月扶单拐行走。10个月X线片出现骨坏死征象。立即停止负重。休息治疗。仍发生股骨头缺血坏死及脱位     

带血管蒂髂骨移植修复髋臼陈旧性骨折和缺损

目的 探讨带血管蒂髂骨移植复髋臼陈旧性骨折和缺损的治疗方法。方法 将骨折的髋臼复位，保留较大的臼顶缘骨块，去除其他游离骨碎片，切取带旋股外侧动静脉升支为血管蒂的骼骨块固定骨折并修复臼顶和后壁的缺损。术后下肢骨牵引3周，关节和肌肉训练3周，而后扶拐行走锻炼。结果 本组9例，随访2－4年，优4例，良5例，3个月后均弃拐行走，髋臼愈合良好，无股骨头再脱位发生。1例轻度跛行，2例长距离行走时髋关节轻度疼痛。结论 以珲旋股外侧动静脉为血管蒂的髂骨块修复髋臼陈旧性骨折和缺损的方法容易操作、效果良好。     

微创空心钉内固定加带血管蒂髂骨瓣植骨术治疗青壮年股骨颈骨折

目的讨论微创切开复位空心加压螺钉内固定加带旋髂深血管蒂髂骨瓣植骨术治疗青壮年股骨颈骨折的手术方法及临床疗效。方法对12例青壮年股骨颈骨折采用部分髂腹股沟入路切口联合部分髋关节前侧髂股骨入路,微创切开复位空心加压螺钉内固定加带旋髂深血管蒂髂骨瓣植骨术治疗。结果12例骨折愈合时间3～8个月,无骨折不愈合及股骨头缺血坏死发生,髋关节功能良好。结论微创切开复位空心加压螺钉内固定加带旋髂深血管蒂髂骨瓣植骨术是治疗青壮年股骨颈骨折非常有效的方法。     

髋臼粉碎性骨折合并压缩性缺损的治疗与对策

目的探讨治疗髋臼粉碎性骨折合并压缩性缺损的手术方法.方法1997年7月～2005年2月,收治髋臼粉碎性骨折合并压缩性缺损43例,其中陈旧性骨折25例,新鲜骨折16例,畸形（大于90 d）2例;复杂骨折与缺损34例,简单骨折与缺损9例.缺损体积3～9 cm^3,平均4.5cm^3.采用改良髋臼入路,应用髋臼三维记忆内固定系统（ATMFS）三维记忆锁定碎骨;髋臼碎骨关节面整复法;自体髂骨髋臼后壁解剖性重建法;自体骨＋人工骨填塞及骨腊隔离法等术后相关措施.结果所有患者随访5～86个月,平均15.7个月.粉碎骨折关节面粉碎＋填补压缩体积至头臼解剖复位31例;自体髂骨后壁“解剖性重建头臼解剖复位”12例;40例患者经过平均5.3个月患侧髋关节功能达到健侧水平,1例股骨头缺血性坏死,2例异位骨化＋股骨头缺血性坏死导致髋关节骨融合.结论本文介绍了治疗髋臼粉碎性骨折合并压缩性缺损的新方法与措施,有效地提高了股骨头与髋臼解剖对应率,为髋关节功能的恢复提供了新的思路.     

双侧股骨头粉碎性骨折并左髋关节后脱位1例

患者 ,男 ,2 8岁 ,因车祸致双髋部肿痛活动受限 3ｈ入院。检查 :左髋关节屈曲、内收内旋畸形、左臀部可触及脱位的股骨头 ,左髋关节弹性固定。右髋肿胀无畸形 ,大转子区叩痛阳性 ,右髋关节活动受限。Ｘ线片示 :左髋关节后脱位并股骨头粉碎性骨折、骨块分离移位。右股骨头粉碎性骨折。ＣＴ扫描示 :左髋关节后脱位、股骨头粉碎性骨折、右侧股骨头粉碎性骨折、髋臼内有 2块游离骨块。诊断 :双侧股骨头粉碎性骨折并左髋关节后脱位。即在硬膜外麻醉下行手法复位。成功后行双下肢股骨髁上牵引。牵引 1周后拍片证实双侧股骨头均有皮质缺损、而且髋…     

髋臼成形术并股骨近端旋转截骨治疗小儿发育性髋关节脱位

目的：评估髋臼成形术并股骨近端旋转截骨治疗发育性髋关节脱位的临床效果。方法：本组患儿48例,男12例,女36例,年龄2．6—8．5岁,平均5．4岁。采用S—P切口,切开关节囊,清理真臼内软组织,复位股骨头;股骨近端旋转截骨,纠正前倾角;髋臼缘上方沿关节囊附着点行弧形截骨,髂骨块植入截骨处,增加股骨头的包容。结果：48例患儿经1．6-5．6年的随访,按照周永德先天性髋脱位疗效评定标准,优32例,良16例,可3例,差4例,手术优良率为86．8％。结论：髋臼成形术并股骨近端旋转截骨是治疗小儿发育性髋关节脱位的一种较为有效的方法。     

Pemberton截骨联合股骨截骨治疗高位脱位型发育性髋关节脱位

目的 探讨高位脱位型发育性髋关节脱位(DDH)手术治疗的体会.方法 65例高位脱位型DDFI,测量髋臼指数、股骨颈前倾角,手术行Pemberton髂骨截骨、股骨粗隆下短缩旋转截骨.结果 髋关节脱位完全复位,髋臼指数恢复到平均21以下,股骨颈前倾角恢复到平均15.1.术后早期获得满意头臼对位,髋关节功能恢复良好.术后3个月以上出现髋关节半脱位和脱位5例,术后1年出现股骨头坏死3例.结论 高位脱位型DDH采取手术综合治疗可取得良好的效果.     

Die chronisch fixierte zentrale Hüftgelenkluxationsfraktur

The acetabulum fracture with chronic dislocation of the femoral head is relatively uncommon. Due to complex morphology and bone defect of the acetabular dome, stable internal fixation is difficult. Primary total hip arthroplasty represents an alternative treatment. We report the case of a 66-year-old patient with a 3-month history of acetabular fracture with central dislocation of the femoral head. The patient was treated with cemented total hip arthroplasty and cancellous bone grafting of the central dome defect for stable cup fixation.     

手术治疗髋关节后脱位合并股骨头与髋臼骨折的体会

目的：探讨髋关节后脱位合并股骨头与髋臼骨折的手术治疗效果与预后。方法：回顾性总结17例髋关节后脱位合并股骨头骨折与髋臼骨折患者的手术治疗经验。所有患者于伤后12h内行髋关节手法复位,并于术前通过CT定位,股骨头骨折采用切开复位可吸收螺钉内固定,髋臼骨折根据情况或予切除,或予钢板内固定。结果：17例患者术后6个月内所有骨折均骨性愈合,无股骨头坏死,按Modifie Daobigne and Postal临床分级标准评定关节功能恢复情况,优8例,良7例,可2例。优良率为88.2%。结论：髋关节后脱位伴股骨头骨折与髋臼骨折,采取手术治疗可获得较好的预后。     

髋关节中心性骨折脱位

目的 探讨髋关节中心性骨折脱位的发病机理、治疗方法和影响预后的因素。方法 新鲜损伤１２例采用三向分力牵引治疗,陈旧损伤３例采用手术治疗。结果 新鲜损伤优良率占８３％,陈旧损伤,以髋关节功能作为评价标准,满意者２例,不满意者１例。结论 良好的治疗效果有赖于完整的髋臼拱顶和股骨头与髋臼的良好关系,治疗的关键是在砸碎的髋臼和向内变位的骨架塑造一个新的臼窝。     

陈旧粉碎性髋臼骨折手术重建修复的策略及预后

背景：陈旧粉碎性髋臼骨折多为高动能严重复合损伤,现逐年增加,且无法早期手术。随着早期切开复位内固定手术的经验积累,对陈旧粉碎性髋臼骨折进行切开复位内固定重建手术势在必行。目的：探讨切开复位内固定手术重建修复陈旧粉碎性髋臼骨折的可行性、方法及疗效。方法：回顾性研究2003年10月至2010年6月应用先纠正髋臼周围骨盆骨折移位及股骨头臼关系,再重建修复髋臼关节面的方法治疗24例陈旧粉碎性髋臼骨折。骨折距手术时间3～6周,平均26.1天。分析手术时间、出血量及输血量、合并伤情况等。术后限制髋部活动4～6周,床上逐渐行关节功能锻炼,3月后下床扶拐活动,并逐渐负重。结果：随访10～36个月,平均15.6个月。关节面骨折复位质量采用Matta标准：解剖复位21髋,满意复位2髋,不满意复位1髋。采用改良Mered＇Aubigne-Postel临床结果评分：优21髋,良2髋,差1髋。术后发生股骨头坏死1例（4.17%）,异位骨化11例（45.83%）,坐骨神经一过性麻痹6例（25%）。结论：先行瘢痕切除松解、整体复位固定髋臼关节外骨折、恢复头臼关系,再应用可吸收螺钉固定、植骨、骨软骨骨折块镶嵌挤压等方法修复碎裂关节面的手术方法治疗陈旧粉碎性髋臼骨折,可达到满意复位及关节功能恢复。     

同侧髋臼骨折合并股骨颈骨折行一期全髋关节置换术的临床研究

目的探讨同侧髋臼骨折合并股骨颈骨折行一期全髋关节置换（THA）的手术方法及其疗效。方法2003年7月至2006年3月,对5例同侧髋臼骨折合并股骨颈骨折的患者行一期THA,均采用生物型人工髋关节,强调髋臼重建结构的稳定性,随访21～54个月（平均34．4个月）;手术距受伤时间5～42d（平均18．6d）。3例2周内手术者,尽可能解剖复位内固定,2例超过4周手术者,在骨折畸形愈合的基础上,不剥离骨痂,给予结构性植骨并重塑髋臼。结果按HHS评分为87．6分,其中优2例,良2例,可1例,随访期间未发生感染、松动和异位骨化等并发症。结论对同侧髋臼骨折合并股骨颈骨折的患者行一期THA,能取得较好疗效,避免切开复位内固定引起的治疗周期长,高并发症,疗效差,甚至短期再次行THA等缺点;重视髋臼结构的稳定性和有翻修经验的医师参与是提高手术疗效的关键。     

Inability to obtain formal informed consent in the face of a standard surgical indication

A thirty-eight-year-old intoxicated man was admitted to the surgical trauma service following a single motor-vehicle accident. He had a severe closed head injury, bilateral pulmonary contusions, a fracture-dislocation of the right acetabulum, and an open injury of the right knee joint. The acetabular fracture pattern was an associated both-column fracture with the femoral head dislocated into a widely displaced posterior-column fracture line. The treating physicians agreed that it would be in the patient's best interest to take him to the operating room for emergent debridement and irrigation of his knee wound. At surgery, the patient also underwent attempted closed reduction of the acetabular fracture and placement of a skeletal traction pin. Radiographs obtained with the patient in traction showed reduction of the femoral head beneath a displaced superior dome fragment, but there remained a 12-mm gap in the posterior column, greater than 3 mm of step incongruity, and a large articular fragment entrapped in the anterior aspect of the hip joint. The patient remained intubated and sedated for several days. Upon weaning from the ventilator, it became evident that his head injury would prevent him from being able to give informed consent in the foreseeable future. The patient's family members refused to become involved with his care or medical decision-making, as he had become completely estranged from them as a result of his chronic alcohol abuse. Further delay in surgical treatment for the acetabular fracture would be associated with greater difficulty in obtaining an anatomic reduction, the potential for additional articular damage to the femoral head, and an increased risk of surgical complications. The question that arises is whether it is in the patient's best interest for the surgeon to proceed with open reduction and internal fixation of the acetabular fracture without having had the opportunity to fully inform him of the treatment options or the risks associated with an extensive surgical exposure.     

Surgical treatment of central acetabular fractures

Surgical treatment is indicated in most displaced acetabular fractures in young adults. The fractures are generally intraarticular and almost invariably involve the weight-bearing area of the acetabulum. Complete or near anatomic reduction is essential for an excellent and long-standing recovery of the hip joint, and this is extremely difficult to accomplish by conservative management. Fifty-eight displaced central acetabular fractures treated surgically were followed from one to 12 years. They were evaluated by anteroposterior and oblique roentgenograms and classified according to the Judet-Letournel system. Although surgical treatment was somewhat delayed and the experience in approaching and dealing with these fractures was limited in many of the early cases, excellent or satisfactory reduction to a less than 3-mm displacement at the articular surface was achieved in 81% of cases. A close agreement was found between the quality of surgical reduction and clinical results as well as between roentgenographic and clinical results at the final follow-up examination, which were satisfactory in 72% and 74%, respectively. The surgical complications were infection in 2% of cases, peroneal nerve palsy in 8.5%, and moderate to severe ectopic ossification in 10% of the patients.     

The floating hip injury: patterns of injury

OBJECTIVE: To evaluate the relationship between mechanism of injury, type of femoral fracture and type of acetabular fracture in floating hip injury.DESIGN: Historical retrospective. PATIENTS: Twenty consecutive patients who sustained a floating hip injury, i.e. simultaneous ipsilateral fracture of the acetabulum and the femur. INTERVENTION: Statistical analysis of the correlation between the mechanism of injury and fracture type. RESULTS: Two main patterns of floating hip injury were observed. The first is the posterior type, which occurs due to a longitudinal force along the femur that causes first, a posterior type fracture of the acetabulum and thereafter, a midshaft femoral fracture. The second pattern is the central type, caused by a lateral blow to the greater trochanter, which then causes a central fracture-dislocation of the acetabulum and a proximal fracture of the femur. CONCLUSIONS: This observation explains the biomechanical nature of this injury and has treatment related implications.     

人工全髋关节置换术中非感染性髋臼骨缺损的治疗策略

目的探讨人工全髋关节置换术在治疗非感染性髋臼骨缺损中的应用。方法 2000年1月至2010年1月间40例非感染性髋臼骨缺损初次行全髋关节置换患者,其中CroweⅢ、Ⅳ型先天性髋关节脱位18例,髋关节感染后融合14例,陈旧性髋臼骨折8例。内移髋关节旋转中心17例,结构性植骨13例,颗粒松质骨打压植骨10例;有14例应用钛网,9例重建钢板,7例加强杯固定。术前术后进行临床评估及X线评估。结果本组手术全部成功,术后无感染发生。本组40例患者随访8～42个月,平均（10.4±2.1）个月,随访时无假体松动,关节无疼痛,患者对手术结果满意,髋关节功能较术前明显改善,术前平均Harris评分为（58.4±6.1）分,术后为（88.6±3.1）分;术后平均Harris评分较术前提高明显,两者比较差异有统计学意义（P〈0.05）。结论对非感染性髋臼节段性和混合性骨缺损进行大块植骨并辅以颗粒骨,并选用牢固的钉板系统固定,将髋臼重建在真臼位置,并尽量采用非骨水泥型臼杯,通过不同的重建方法可以获得良好的髋关节功能。