Guan Huapeng, Liu Xinwei, Su Jiacan, Zhang Chuncai, Sun Jianzhong, Fu Qingge
Department of Orthopaedics, the Affiliated Changhai Hospital, Second Military Medical University, Shanghai, 200433, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Mar;23(3):265-7.
To summarize the treatment method and to analyze short-term therapeutic effect of Pipkin fracture.
From January 2002 to January 2007, 14 cases of Pipkin fracture were treated. There were 10 males and 4 females with an average of 33.5 years (ranged from 28 to 52 years). Fractures were caused by traffic accident. According to Pipkin's classification, there were 4 cases of type I, 6 cases of type II, 2 cases of type III and 2 cases of type IV. The time from injury to operation was 24 hours to 8 weeks. All patients received open reduction under Kocher-Langenbeck approach, ameliorative posterior-lateral approach or combined approaches. Absorbable screws and suture line internal fixation were performed in fracture of the femoral head, titanium cannulated screws were used to fix the femoral intertrochanteric fracture in type III, and acetabular tridimensional memory fixation systems were used to fix the posterior acetabular fracture in type IV.
All cases had one-stage wound healing, no complications of deep infection and thrombosis of deep vein of lower limb occurred. All the patients were followed up for 12-48 months (mean 26 months). One case of type III fracture for Pipkin had necrosis of femoral head after 1 year of reduction and fixation, and received total hip replacement; other patients achieved bony healing after 6-10 months (mean 8 months). According to D'Aubigne-Postel score, the results were excellent in 5 cases, good in 6 cases, fair in 2 cases and poor in 1 case; the excellent and good rate was 78.6%.
It is important for the patients with Pipkin fracture to early diagnose, to select proper operation approach, to stably fix fracture and to manage after operation in reducing complication and recovering hip joint function.
总结Pipkin骨折的治疗方法并分析其短期治疗效果。
2002年1月至2007年1月，治疗14例Pipkin骨折患者。其中男性10例，女性4例，平均年龄33.5岁（28至52岁）。骨折均由交通事故所致。按Pipkin分型，Ⅰ型4例，Ⅱ型6例，Ⅲ型2例，Ⅳ型2例。受伤至手术时间为24小时至8周。所有患者均采用Kocher-Langenbeck入路、改良后外侧入路或联合入路进行切开复位。股骨头骨折采用可吸收螺钉及缝线内固定，Ⅲ型采用钛空心钉固定股骨转子间骨折，Ⅳ型采用髋臼三维记忆内固定系统固定髋臼后壁骨折。
所有病例切口均一期愈合，未发生深部感染及下肢深静脉血栓等并发症。所有患者均获随访，时间为12至48个月（平均26个月）。1例Ⅲ型Pipkin骨折患者复位固定1年后出现股骨头坏死，行全髋关节置换术；其余患者均于6至10个月（平均8个月）骨性愈合。按D'Aubigne-Postel评分标准，优5例，良6例，可2例，差1例；优良率为78.6%。
Pipkin骨折患者早期诊断、选择合适的手术入路、牢固固定骨折及术后处理对减少并发症、恢复髋关节功能至关重要。
