Durakbaşa Oğuz, Okan Nedret, Canbora Kerem, Görgeç Mücahit
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Kliniği), Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2005;39(2):133-41.
We evaluated the long-term results of conservative and surgical treatment and the effect of prognostic factors on these results in patients with traumatic dislocation of the hip.
The study included 30 patients (27 males, 3 females; mean age 35 years; range 16 to 69 years) with traumatic hip dislocations. The most common cause was traffic accidents (80%). Fifteen patients underwent closed reduction for posterior (n=10), anterior (n=2), and central (n=3) dislocations, of which eight were isolated and seven were fracture dislocations. Open reduction was performed in 15 patients with posterior (n=14) and central (n=1) dislocations. Of these, five patients had isolated hip trauma and 10 patients had multiple trauma. Surgery was performed within the first 24 hours (n=6) or between five and 21 days (n=9). Posterior, central, and anterior dislocations were classified according to the Thompson-Epstein, Judet, and Epstein classification systems, respectively. The Pipkin classification was also used for dislocations with femoral head fractures. The results were evaluated according to the criteria proposed by Matta. The mean follow-up was 49 months (range 16 to 84 months).
Following closed reduction, the results were satisfactory (very good or good) in 11 patients (73.3%, all isolated dislocations and three posterior fracture dislocations) and unsatisfactory (moderate or poor) in four patients (26.7%). Following open reduction, nine patients (60%) with posterior fracture dislocations had satisfactory and six patients (40%) had unsatisfactory outcome. The results were unsatisfactory in all the central dislocations. One patient developed avascular necrosis of the femur head and four patients developed degenerative arthritis following closed reduction. Degenerative arthritis was seen in six patients after surgical treatment, two of whom also had avascular necrosis.
Our data may provide insight into the factors affecting the prognosis of traumatic hip dislocations treated by closed or open reduction.
我们评估了保守治疗和手术治疗的长期结果，以及预后因素对创伤性髋关节脱位患者这些结果的影响。
该研究纳入了30例创伤性髋关节脱位患者（27例男性，3例女性；平均年龄35岁；范围16至69岁）。最常见的原因是交通事故（80%）。15例患者接受了后脱位（n = 10）、前脱位（n = 2）和中心脱位（n = 3）的闭合复位，其中8例为单纯脱位，7例为骨折脱位。15例后脱位（n = 14）和中心脱位（n = 1）患者接受了切开复位。其中，5例患者为单纯髋关节创伤，10例患者为多发伤。手术在最初24小时内进行（n = 6）或在5至21天之间进行（n = 9）。后脱位、中心脱位和前脱位分别根据汤普森 - 爱泼斯坦、朱代和爱泼斯坦分类系统进行分类。皮普金分类也用于伴有股骨头骨折的脱位。根据马塔提出的标准评估结果。平均随访时间为49个月（范围16至84个月）。
闭合复位后，11例患者（73.3%，均为单纯脱位和3例后骨折脱位）结果满意（非常好或好），4例患者（26.7%）结果不满意（中等或差）。切开复位后，9例后骨折脱位患者（60%）结果满意，6例患者（40%）结果不满意。所有中心脱位结果均不满意。1例患者发生股骨头缺血性坏死，4例患者闭合复位后发生退行性关节炎。手术治疗后6例患者出现退行性关节炎，其中2例也有缺血性坏死。
我们的数据可能有助于深入了解影响通过闭合或切开复位治疗的创伤性髋关节脱位预后的因素。
