Sahin Vedat, Karakaş Eyüp S, Aksu Sirri, Atlihan Doğan, Turk C Yildirim, Halici Mehmet
2nd Orthopaedic Clinic, Ankara Education and Training Hospital, Turkey.
J Trauma. 2003 Mar;54(3):520-9. doi: 10.1097/01.TA.0000020394.32496.52.
Traumatic dislocation and fracture-dislocation of the hip is an absolute orthopedic emergency that is steadily increasing in incidence. Early recognition and prompt, stable reduction is the essence of successful management. A delay in recognition and reduction leads to preventable complications and morbidity. The purpose of this retrospective study is to identify prognostic factors that predict long-term outcome after hip dislocation.
Between 1980 and 1994, 107 patients with traumatic dislocation of the hips were treated, and 62 are reviewed in this study. There were 57 posterior fracture-dislocations and 5 anterior-obturator dislocations. All of the patients' charts were reviewed. The physical examinations and radiologic controls of the patients who were called for last follow-up examination were performed by the first two authors (V.S. and E.K.). Anterior and posterior fracture-dislocations were classified according to the classification system developed by Steward and Milford and femoral head fractures were classified according to the Pipkin classification. All of the hips were classified as very good, good, medium, fair, and poor according to the functional evaluation system described by Merle d'Aubigne. Statistical analysis of the results was performed.
There were 47 male patients and 15 female patients, with ages ranging from 14 to 72 years (mean, 34.5 years). Traffic accidents constituted the leading cause of traumatic dislocation in this series (52 cases [83.9%]). Associated injuries were found in 44 cases (71%). Fifty patients were treated with closed reduction, and 12 patients were treated with open reduction. Thirty-five hips (56.5%) were reduced within 12 hours. Full weight-bearing was resumed between 2 and 10 weeks (average, 8 weeks) after injury. In follow-up periods ranging from 3.6 years to 18.4 years (mean, 9.6 years), 44 patients (71%) had very good or good to medium results. Ten patients (16.1%) developed late posttraumatic osteoarthritis of the hip, and 5 patients (9.6%) developed osteonecrosis of the femoral head. In this study, it is found that the time between injury and reduction and the associated injuries are the most important factors in long-term prognosis.
We believe that good results were obtained in patients with early, stable, and accurate reductions by either closed or open methods. Concentric reduction absolutely should be confirmed by radiographs of the pelvis and, if necessary, by computed tomographic scan. The routine use of seat belts could have prevented many of these injuries.
创伤性髋关节脱位及骨折脱位是绝对的骨科急症，其发病率在持续上升。早期识别并迅速、稳定地复位是成功治疗的关键。识别和复位的延迟会导致可预防的并发症和发病率增加。本回顾性研究的目的是确定预测髋关节脱位后长期预后的预后因素。
1980年至1994年间，107例创伤性髋关节脱位患者接受了治疗，本研究回顾了其中62例。有57例后骨折脱位和5例前闭孔脱位。查阅了所有患者的病历。最后一次随访检查的患者的体格检查和影像学检查由前两位作者（V.S.和E.K.）进行。前、后骨折脱位根据Steward和Milford制定的分类系统进行分类，股骨头骨折根据Pipkin分类进行分类。根据Merle d'Aubigne描述的功能评估系统，所有髋关节被分为非常好、好、中等、尚可和差。对结果进行了统计分析。
有47例男性患者和15例女性患者，年龄范围为14至72岁（平均34.5岁）。交通事故是本系列创伤性脱位的主要原因（52例[83.9%]）。44例（71%）发现有合并伤。50例患者接受了闭合复位，12例患者接受了切开复位。35个髋关节（56.5%）在12小时内复位。受伤后2至10周（平均8周）恢复完全负重。在3.6年至18.4年（平均9.6年）的随访期内，44例患者（71%）的结果为非常好或良好至中等。10例患者（16.1%）发生了创伤后晚期髋骨关节炎，5例患者（9.6%）发生了股骨头坏死。在本研究中，发现受伤与复位之间的时间以及合并伤是长期预后的最重要因素。
我们认为，通过闭合或切开方法进行早期、稳定和准确的复位，患者可获得良好的结果。必须通过骨盆X线片确认同心复位，如有必要，通过计算机断层扫描确认。常规使用安全带本可预防许多此类损伤。
