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.     

可吸收钉内固定治疗股骨头骨折并髋关节后脱位的临床体会

目的 总结可吸收钉内固定治疗股骨头骨折并髋关节后脱位的临床体会. 方法 采用可吸收钉内固定治疗股骨头骨折并髋关节后脱位患者7例.股骨头骨折按照Pipkin's骨折分型:Ⅰ型2例,Ⅱ型3例,Ⅲ型1例,Ⅳ型1例.股骨头骨折块最小2.0 cm×2.0 cm×2.5 cm,最大4.5 cm×3.5 cm×4.0 cm.受伤至就诊时间为1 h～12d.Ⅰ型2例和Ⅱ型3例经Smith-Peterson入路,Ⅲ型1例和Ⅳ型1例采用Kocher-Langenbeck入路,以直径4.5 mm,长度35～55mm的可吸收螺钉内固定股骨头骨折块.结果 本组7例均获随访,平均时间31.7(14 ～57)个月.按Thompson-Epstein临床和影像学评定标准评定疗效,优3例,良2例,可1例,差1例,优良率71.4％.1例Ⅳ型股骨头骨折患者,术后出现股骨颈骨折不愈合,1年后出现股骨头坏死,伤后2.5年行人工全髋置换术,其余均完全愈合. 结论 可吸收钉治疗股骨头骨折并髋关节后脱位具有无需二次手术、取材方便等优点,值得临床推广应用.     

股骨头骨折的治疗

目的评价股骨头骨折的治疗方法并分析其结果.方法分析18例股骨头骨折患者,采用Yoon's分类方法,Ⅰ型(3例),治疗方法为手术切除小的骨折片;Ⅱ型(9例)及Ⅲ型(4例),采用骨折切开复位可吸收螺丝钉内固定术;Ⅳ型(2例),行全髋关节置换术.结果术后X线检查证实骨折复位良好,全髋关节置换者假体位置良好.随访3～5年,采用Epstein评价方法,优4例,良9例,可3例,差2例.结论由于Ⅰ型骨折复位固定较为困难,应切除小的骨折片,Ⅱ型及Ⅲ型损伤应早期切开复位,行螺丝钉内固定术,对于Ⅳ型骨折,全髋关节置换术是一个好的治疗方法.     

股骨头骨折的手术治疗探讨

目的探讨股骨头骨折的治疗方法和临床效果。方法根据改良P ipk in氏分型方法,对20例股骨头骨折病人,采用手术治疗18例。其中股骨头骨折小骨块切除6例,骨折块复位内固定11例,髋关节置换1例。结果平均随访2.3年,按髋关节功能评定标准和X线结果,优7例,良7例,可3例,差1例,总优良率为78%。结论重视按股骨头骨折类型选择合适的治疗方式。Ⅰ型骨折小骨折块切除是较好选择,Ⅱ型和Ⅲ型需及时解剖复位内固定,Ⅳ型骨折是否行关节置换取决于年龄,年轻者尽可能保留原关节。     

股骨粗隆间骨折合并同侧股骨干骨折的手术治疗

目的：探讨股骨粗隆间骨折合并同侧股骨干骨折的手术治疗方法及疗效。方法：回顾分析我院自1998年1月至2005年12月收治股骨粗隆间骨折合并同侧股骨干骨折患者18例,全部病例均采用手术切开复位内固定,股骨粗隆间骨折应用动力髋内固定,股骨干骨折采用记忆合金环抱器内固定。结果：术后随访2～8年,平均4．2年。全部病例均获骨性愈合,疗效满意。结论：股骨粗隆间骨折合并同侧股骨干骨折在下肢骨折中相对较少,但处理较为复杂和困难,治疗有一定难度,使用动力髋与记忆合金环抱器同时进行内固定,方法简单,固定牢靠,患肢可早期进行功能锻炼,这种方法是治疗单侧肢体多处骨折较好的方法之一。     

小切口双极股骨头置换治疗高龄股骨颈骨折

目的 对比后外侧小切口双极股骨头置换术和后外侧标准入路双极股骨颈移位骨折的术后早期疗效.方法 124例老年新鲜移位的股骨颈骨折患者,平均年龄78.4岁,分成2组:A组62例经后外侧小切中口行双极人工股骨头置换术;B组62例经后外侧标准入路行双极人工股骨头置换术.对比的指标包括:皮肤切口的长度、手术时间、失血量的总体估计、住院治疗时间的长短、应用助步器的时间、并发症(术后关节脱位和深静脉血栓形成)发生率,以及术后关切功能.结果 除术后并发症和关节功能无显著差异外,A组各项指标均优于B组中,并且具有显著性差异.结论 经后外侧小切口行双极股骨头置换术治疗高龄股骨颈移位骨折比经后外侧标准入路行双极股骨头置换术术后早期疗效优越.     

股骨远端骨折的外科治疗

目的:探讨股骨远端骨折手术治疗的方法和临床疗效。方法选择股骨远端骨折手术治疗37例,根据AO/A S IF分型,A型8例,B型9例,C型20例,分别采用股骨髁支持钢板、L-梯形钢板、逆行带锁髓内钉、拉力螺钉进行固定,术后随访6个月~8年。结果6例骨折不愈合、3例出现化脓性骨和膝关节感染、3例出现钢板断裂。根据K olm enrt股骨远端功能评定标准,优17例,良14例,一般2例,差4例,优良率83.7%。结论手术治疗股骨远端骨折能最大限度获得骨折复位和膝关节功能的恢复,临床疗效满意,是治疗股骨远端骨折较理想的方法。     

Application of Ganz Surgical Hip Dislocation Approach in Pediatric Hip Diseases

Background

Ganz surgical hip dislocation is useful in the management of severe hip diseases, providing an unobstructed view of the femoral head and acetabulum. We present our early experience with this approach in pediatric hip diseases.

Methods

Twenty-three hips of 21 patients with pediatric hip diseases treated using the Ganz surgical hip dislocation approach were the subjects of this study. The average age at the time of surgery was 15.7 years. There were 15 male and 6 female patients who were followed for an average of 15.1 months (range, 6 to 29 months). Diagnoses included hereditary multiple exostoses in 9 hips, slipped capital femoral epiphysis in 7, Legg-Calvé-Perthes disease in 4, osteoid osteoma in 1, pigmented villonodular synovitis in 1, and neonatal septic hip sequelae in 1. Medical records were reviewed to record diagnoses, principal surgical procedures, operative time, blood loss, postoperative rehabilitation, changes in the range of hip joint motion, and complications.

Results

Femoral head-neck osteochondroplasty was performed in 17 patients, proximal femoral realignment osteotomy in 6, open reduction and subcapital osteotomy for slipped capital femoral epiphysis (SCFE) in 2, core decompression and bone grafting in 2, hip distraction arthroplasty in 2, and synovectomy in 2. Operative time averaged 168.6 minutes when only osteochondroplasty and/or synovectomy were performed. Hip flexion range improved from a preoperative mean of 84.7° to a mean of 115.0° at the latest follow-up visit. Early continuous passive motion and ambulation were stressed in rehabilitation. No avascular necrosis of the femoral head was noted up to the time of the latest follow-up visit, except for in one SCFE patient whose surgical intervention was delayed for medical reasons.

Conclusions

Ganz surgical hip dislocation provides wide exposure of the femoral head and neck, which enables complete and precise evaluation of the femoral head and neck contour. Hence, the extensive impinging bump can be excised meticulously, and the circulation of the femoral head can be monitored during surgery. The Ganz procedure was useful in severe pediatric hip diseases and allowed for quick rehabilitation with fewer complications.     

Treatment of Periprosthetic Femoral Fractures in Hip Arthroplasty

Background

We analyzed the radiological and clinical results of our study subjects according to the management algorithm of the Vancouver classification system for the treatment of periprosthetic femoral fractures in hip arthroplasty.

Methods

We retrospectively reviewed 18 hips with postoperative periprosthetic femoral fractures. The average follow-up was 49 months. The fracture type was determined based on the Vancouver classification system. The management algorithm of the Vancouver classification system was generally applied, but it was modified in some cases according to the surgeon''s decision. At the final follow-up, we assessed the radiological results using Beals and Tower''s criteria. The functional results were also evaluated by calculating the Harris hip scores.

Results

Seventeen of 18 cases (94.4%) achieved primary union at an average of 25.5 weeks. The mean Harris hip score was 92. There was 1 case of nonunion, which was a type C fracture after cemented total hip arthroplasty, and this required a strut allograft. Subsidence was noted in 1 case, but the fracture was united despite the subsidence. There was no other complication.

Conclusions

Although we somewhat veered out of the management algorithm of the Vancouver classification system, the customized treatment, with considering the stability of the femoral stem and the configuration of the fracture, showed favorable overall results.     

股骨长节段严重粉碎性骨折的外科治疗

目的探讨股骨长节段严重粉碎性骨折的临床特点与外科治疗方法。方法回顾性分析32例股骨长节段严重粉碎性骨折的临床资料并进行总结。32例均行切开复位与内固定。结果随访时间10个月～4年2个月,平均3.5年,全部患者均获骨性愈合,愈合时间3～7个月,平均4.6个月,本组病例无股骨短缩或成角畸形,肢体功能恢复满意。结论股骨长节段严重粉碎性骨折多系高能量暴力所致,受伤机制复杂。内固定宜选择整体化的骨折内固定方式。     

先天性髋脱位治疗中股骨头坏死的预防与补救治疗

自１９８７年９月至１９９３年２月我院收治先天性髋脱位患儿２８例，４５髋。其中闭合复位治疗２１例，３４髋，包括７例１３髋曾经院外闭合复位不成功者，均在直视下进行内收肌、髂腰肌松解，以轻柔的手法复位，使复位获得成功。对高脱位患髋采用加大髋关节屈曲位的蛙式石膏固定，避免了股骨头缺血坏死发生。７例１１髋为来院前闭合复位造成股骨头缺血坏死者，以及伴有髋关节半脱位者，进行补救治疗，取得了髋关节解剖复位，股骨头重建血运的效果     

Hip Arthroplasty After Surgical Treatment of Intertrochanteric Hip Fractures

Background

Although use of intramedullary hip screws (IMHS) for intertrochanteric (IT) hip fractures has become more common, limited data have suggested difficulties in conversion to hip arthroplasty. The present study investigates whether conversion of failed IT fracture fixation with an intramedullary vs extramedullary device leads to different rates or types of complications or decreased arthroplasty survivorship.

成人先天性髋脱位(CDH)的手术治疗

目的：探讨成人先天性髋脱位的手术治疗。方法：对7例(9髋)成人先天性髋脱位病例应用股骨髁上牵引、髂剥及骨盆截骨加盖植骨术治疗，随访1～4a，按Muller和Seddon的评分标准进行主、客观评估临床疗效。结果：功能及步态满意率85．7％。结论：成年人先天性髋关节脱位单一的治疗方法难以取得满意的疗效，髂剥及骨盆截骨加盖植骨术治疗对功能的恢复有较好的效果。     

股骨粗隆间骨折的外科治疗策略及疗效分析

目的探讨不同术式治疗股骨粗隆间骨折的临床效果。方法回顾性分析97例股骨粗隆间骨折,按照Evans分型:Ⅰ型13例,Ⅱ型28例,Ⅲ型37例,Ⅳ型15例,Ⅴ型4例。其中采用DHS内固定51例,髓内固定系统(Gamma钉和PFN)27例,人工关节置换术19例。结果术后随访83例,骨折全部愈合,愈合时间4～6个月。术后并发症包括髋内翻5例;钢板断裂1例,骨折畸形愈合4例。根据董纪元等制定的疗效评定标准,优43例,良28例,可5例,差7例,总优良率85.5%。结论根据骨折分型,结合老年患者骨质疏松情况选择适当的术式可以提高股骨粗隆间骨折的疗效,减少术后并发症。Evans Ⅰ、Ⅱ型稳定性股骨粗隆间骨折首选DHS内固定,Ⅲ～Ⅴ型不稳定性骨折可选择髓内固定系统,不稳定性骨折合并明显骨质疏松的高龄患者宜选择人工关节置换术。     

同侧股骨干合并股骨颈骨折的手术治疗

目的探讨同侧股骨干合并股骨颈骨折的临床特点及治疗方法。方法选择2000年2月至2006年4月,14例经手术复位内固定治疗的同侧股骨干合并股骨颈骨折患者进行回顾性分析,其中股骨颈骨折漏诊4例,采用股骨重建髓内钉固定4例,股骨逆行交锁髓内钉及空心螺钉固定5例,股骨交锁髓内钉结合空心螺钉固定2例,股骨干骨折加压钢板及空心钉固定3例。结果本组14例均获随防,随访时间为12~48个月,平均27个月。14例股骨干骨折均在术后7个月内获得愈合,股骨颈骨折在6个月内愈合。无切口感染、血管神经损伤、内固定断裂及股骨头缺血性坏死等并发症发生。所有患者髋关节功能的恢复无活动障碍,膝关节活动受限1例。结论同侧股骨干合并股骨颈骨折时股骨颈骨折常常无移位或轻度移位,其漏诊率高,在骨折治疗的微创理念指导下,运用医生熟练掌握的内固定方法,经过合理的术后功能锻炼,可获得满意的临床疗效。