Swiontkowski M F, Thorpe M, Seiler J G, Hansen S T
Department of Orthopaedics, Harborview Medical Center, Seattle, Washington 98104.
J Orthop Trauma. 1992;6(4):437-42.
Because of the controversy surrounding the selection of the surgical approach for the operative management of femoral head fractures, we retrospectively reviewed the combined experience with femoral head fractures at two major trauma centers. Forty-three femoral head fractures in 41 patients were identified. Twenty-six of the 43 fractures were Pipkin types I and II, and were managed operatively. Of the 26 patients, 12 with > 2 years of follow-up were managed with posterior surgical approaches and 12 with anterior surgical approaches. These patients were assessed with respect to operative time, estimated blood loss and function, and the radiographs for reduction, avascular necrosis, and heterotopic ossification. There was a significant decrease in operative time, estimated blood loss, and improved visualization and fixation with the anterior approach; however, there was a significant increase in functionally significant heterotopic ossification. The functional results in the two groups were identical; 67% good and excellent in each. There were no cases of avascular necrosis of the femoral head associated with an anterior approach. Because of the greater ease of access to the fracture, the anterior approach is recommended when operative reduction of a displaced Pipkin type I or II is indicated, but newer methods of minimizing heterotopic ossification must be developed.
由于股骨头骨折手术治疗的手术入路选择存在争议，我们回顾性分析了两个主要创伤中心治疗股骨头骨折的综合经验。共确定了41例患者的43处股骨头骨折。43处骨折中有26处为Pipkin I型和II型，采用手术治疗。在这26例患者中，12例随访超过2年，采用后入路手术治疗，12例采用前入路手术治疗。对这些患者进行了手术时间、估计失血量和功能评估，并对X线片进行了复位、缺血性坏死和异位骨化评估。前入路手术时间、估计失血量显著减少，可视化和固定效果改善；然而，功能上显著的异位骨化显著增加。两组的功能结果相同，每组优良率均为67%。前入路未出现与股骨头缺血性坏死相关的病例。由于骨折部位更容易暴露，当需要对移位的Pipkin I型或II型骨折进行手术复位时，建议采用前入路，但必须开发更新的方法来减少异位骨化。
