Yue J J, Sontich J K, Miron S D, Peljovich A E, Wilber J H, Yue D N, Patterson B M
Department of Orthopaedic Surgery, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio, USA.
J Orthop Trauma. 2001 Mar-Apr;15(3):170-6. doi: 10.1097/00005131-200103000-00004.
Acute blood flow to the femoral head has been postulated to be affected negatively by traumatic acetabular fracture or dislocation. To the best of our knowledge, a prospective study that has examined acute changes in blood flow to the femoral head with respect to the timing of reduction and the effect of open reduction and internal fixation after acetabular fracture or dislocations has not been performed.
From June 1994 to February 1996, fifty-four consecutive patients with hip dislocations with or without fractures of the acetabulum were entered into this investigation. The patients were categorized into three groups: isolated dislocations, fractures or dislocations requiring open reduction and internal fixation, and isolated acetabular fractures without dislocation but requiring open reduction and internal fixation. Single-photon emission computed tomography (SPECT) scans were obtained after relocations and preoperatively and postoperatively after open reduction and internal fixation of displaced acetabular fractures.
The median dislocation time for all patients flow was 4.00 hours (range 1 to 24 hours). SPECT scanning showed a low blood flow pattern in five (9.25 percent) patients. A low blood flow pattern was seen in patients with early and late relocation times. Open reduction and internal fixation was not statistically associated with an avascular pattern of blood flow. Forty-two (78 percent) of our patients were available for follow-up, with an average of 24.3 months and a minimum of one year. There was one false-positive, one false-negative, and thirty-eight true-negative scans.
A global loss of scintillation in the femoral head as determined by SPECT scanning occurs in some patients with hip dislocations and fractures or dislocations of the acetabulum in the early injury period. Changes in blood flow occurred in patients with short (one hour) and long (twenty-four hours) dislocation times. However, the development of avascular necrosis could not be predicted by early SPECT scanning. Until further multicenter studies are performed, SPECT scanning cannot be recommended on an acute or routine basis to predict those patients who will develop avascular necrosis. Operative approaches for open reduction of the hip and internal fixation of acetabular fractures do not appear to affect blood flow to the femoral head. Although a golden time to relocation cannot be fully established from this study, early relocation is advised to decrease the potential risk of vascular spasm, scarring, and subsequent avascular necrosis.
据推测，创伤性髋臼骨折或脱位会对股骨头的急性血流产生负面影响。据我们所知，尚未有前瞻性研究探讨股骨头血流在复位时机以及髋臼骨折或脱位后切开复位内固定效果方面的急性变化。
1994年6月至1996年2月，54例连续的髋臼骨折合并或不合并髋关节脱位患者纳入本研究。患者分为三组：单纯脱位、需要切开复位内固定的骨折或脱位、无脱位但需要切开复位内固定的单纯髋臼骨折。对髋臼骨折移位患者进行复位后、切开复位内固定术前及术后均行单光子发射计算机断层扫描（SPECT）。
所有患者的中位脱位时间为4.00小时（范围1至24小时）。SPECT扫描显示5例（9.25%）患者血流模式降低。早期和晚期复位患者均可见血流模式降低。切开复位内固定与无血管血流模式无统计学关联。42例（78%）患者获得随访，平均随访24.3个月，最短1年。有1例假阳性、1例假阴性和38例真阴性扫描。
在损伤早期，部分髋关节脱位、髋臼骨折或骨折脱位患者经SPECT扫描显示股骨头闪烁完全缺失。脱位时间短（1小时）和长（24小时）的患者均出现血流变化。然而，早期SPECT扫描无法预测缺血性坏死的发生。在进行进一步的多中心研究之前，不建议在急性或常规情况下进行SPECT扫描以预测哪些患者会发生缺血性坏死。髋臼骨折切开复位及内固定的手术方式似乎不影响股骨头血流。虽然本研究无法完全确定复位的黄金时间，但建议早期复位以降低血管痉挛、瘢痕形成及随后缺血性坏死的潜在风险。
