Tang Yanfeng, Liu Youwen, Zhu Yingjie, Li Jianming, Li Wuyin, Li Qiyi, Jia Yudong
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Nov;29(11):1327-31.
To discuss the value of surgical hip dislocation approach in the treatment of femoral head fracture.
A retrospectively analysis was made on the clinical data of 15 patients with femoral head fractures treated through surgical hip dislocation approach between January 2010 and February 2013. There were 11 men and 4 women with an average age of 30.8 years (range, 15-63 years). The causes included traffic accident injury in 9 cases, falling injury from height in 5 cases, and sports injury in 1 case. According to Pipkin typing, 2 cases were rated as type I, 7 cases as type II, 1 case as type III, and 5 cases as type IV. The interval of injury and operation was 2-10 days (mean, 4.1 days). Reduction was performed in 10 patients within 6 hours after injury, and then bone traction was given for 4-6 weeks except 5 patients who received reduction in the other hospital.
Primary healing of incision was obtained in all patients after surgery without complications of dislocation and lower limbs deep venous thrombosis. The mean follow-up time was 29.9 months (range, 25-36 months). During follow-up, there was no infection, breakage of internal fixation, or nonunion of femoral greater trochanter fracture. In 3 patients having necrosis of the femoral head, 2 had no obvious symptoms [staging as IIa and IIb respectively according to Association Research Circulation Osseous (ARCO) staging system], and 1 (stage IIIb) had nonunion of the femoral neck fracture, who underwent total hip arthroplasty (THA). In 4 patients having myositis ossificans (2 cases of grade I, 1 case of grade II, and 1 case of grade III based on Brooker grading), no treatment was given in 3 cases and the focus was removed during THA in 1 case. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 9 cases, good in 3 cases, fair in 1 case, and poor in 2 cases, and the excellent and good rate was 80%.
Surgical hip dislocation approach can not only protect the residual vessels of the femoral head but also fully expose the acetabulum and femoral head, which is the ideal approach for the treatment of femoral head fractures.
探讨髋关节脱位手术入路在股骨头骨折治疗中的价值。
回顾性分析2010年1月至2013年2月采用髋关节脱位手术入路治疗的15例股骨头骨折患者的临床资料。其中男11例，女4例，平均年龄30.8岁（15 - 63岁）。致伤原因包括交通事故伤9例，高处坠落伤5例，运动损伤1例。按Pipkin分型，Ⅰ型2例，Ⅱ型7例，Ⅲ型1例，Ⅳ型5例。受伤至手术时间为2 - 10天（平均4.1天）。10例患者于伤后6小时内行复位，除5例在外院复位者外，其余行骨牵引4 - 6周。
所有患者术后切口均一期愈合，无脱位及下肢深静脉血栓形成等并发症。平均随访时间29.9个月（25 - 36个月）。随访期间无感染、内固定断裂及股骨大转子骨折不愈合情况。3例出现股骨头坏死，2例无症状[根据骨循环研究协会（ARCO）分期系统分别为Ⅱa和Ⅱb期]，1例（Ⅲb期）出现股骨颈骨折不愈合，行全髋关节置换术（THA）。4例出现骨化性肌炎（根据Brooker分级，Ⅰ级2例，Ⅱ级1例，Ⅲ级1例），3例未予处理，1例在THA时切除病灶。末次随访按Thompson - Epstein评分标准，优9例，良3例，可1例，差2例，优良率为80%。
髋关节脱位手术入路既能保护股骨头残留血管，又能充分显露髋臼及股骨头，是治疗股骨头骨折的理想入路。
