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同侧髋臼后壁骨折合并股骨头后脱位的罕见组合。

Unusual combination of posterior femoral head dislocation with anterior and posterior wall fractures in the ipsilateral acetabulum.

作者信息

Chen Wei, Su Yanling, Zhang Yingze, Zhang Qi, Zheng Zhanle, Pan Jinshe

机构信息

Department of Orthopedic Surgery, Third Hospital of Hebei Medical University, Hebei, China.

出版信息

Orthopedics. 2010 Jun 9;33(6):440. doi: 10.3928/01477447-20100429-29.

Abstract

Although hip dislocation combined with acetabular fracture is not an uncommon injury, anterior acetabular wall fractures rarely occur in patients who have posterior fracture-dislocations of the hip. This article presents a unique case of anterior and posterior wall fractures of the ipsilateral acetabulum in a patient who sustained traumatic posterior hip dislocation that resulted from a high-speed motor vehicle accident. The initial imaging evaluation, which did not include the obturator oblique view, revealed no concomitant anterior acetabular wall fracture. Repeated manipulative reductions were unsuccessful in reducing the displaced hip joint. Pelvic computed tomography (CT) scans revealed the initially missed anterior acetabular wall fracture fragments incarcerated in the left hip joint in addition to the hip dislocation and the posterior acetabular wall fracture. The incarcerated bone fragments lay between the anterior wall and the femoral head, and between the posterior wall and the femoral head, which appeared to derive from both anterior and posterior acetabular walls, respectively. Open reduction and internal fixation was performed to manage the posterior dislocation and associated acetabular fractures. Intraoperatively, the major anterior wall fragment was used to reconstruct the defected posterior wall. This case highlights the necessity of suspicion and pre- and postoperative monitoring of the obturator oblique view and CT scans to detect the potentially existing anterior acetabular wall fracture. Early surgical intervention is important to guarantee satisfactory outcomes of such complex fracture-dislocation injuries.

摘要

尽管髋关节脱位合并髋臼骨折并非罕见损伤,但髋臼前壁骨折在髋关节后脱位骨折患者中很少发生。本文介绍了一名因高速机动车事故导致创伤性髋关节后脱位患者同侧髋臼前后壁骨折的独特病例。最初的影像学评估未包括闭孔斜位片,未发现合并髋臼前壁骨折。反复手法复位未能成功复位移位的髋关节。骨盆计算机断层扫描(CT)显示,除髋关节脱位和髋臼后壁骨折外,最初漏诊的髋臼前壁骨折碎片嵌顿在左髋关节内。嵌顿的骨碎片分别位于前壁与股骨头之间以及后壁与股骨头之间,似乎分别来自髋臼前壁和后壁。进行了切开复位内固定术以处理后脱位及相关髋臼骨折。术中,主要的前壁碎片用于重建缺损的后壁。该病例强调了怀疑以及术前和术后对闭孔斜位片和CT扫描进行监测以检测潜在存在的髋臼前壁骨折的必要性。早期手术干预对于确保此类复杂骨折脱位损伤获得满意疗效很重要。

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