Yu Yi-Hsun, Hsu Yung-Heng, Chou Ying-Chao, Tseng I-Chuan, Su Chun-Yi, Wu Chi-Chung
1 Division of Orthopedic Traumatology, Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
2 Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
J Orthop Surg (Hong Kong). 2017 Jan;25(1):2309499016684970. doi: 10.1177/2309499016684970.
Pipkin type IV femoral head (FH) fracture was thought as poor prognosis. There were several surgical approaches and treatments for this difficult fracture. However, there was no one treatment superior to another. We reviewed a serious of patients with Pipkin type IV FH fracture underwent surgery via a modified Gibson approach.
We reviewed a consecutive series of nine patients with Pipkin type IV FH fracture under surgery via a modified Gibson approach between 2012 and 2013. The surgical procedure was completely described, and the radiological outcome and the functional outcome were also reviewed.
The mean follow-up duration was 17 (12-30) months. The mean Merle d'Aubigne score was 16 (8-19). Seven patients had anatomical reductions, and two had imperfect reductions by Matta's grading. There was no early posttraumatic osteoarthritis during the follow-up period. One patient with early post-traumatic osteonecrosis 3 months after index surgery underwent total hip arthroplasty.
Through this surgery approach to fix the FH and the acetabulum, the radiological and the functional results were satisfactory. We still need more patients with prospective study to find an optimal surgical approach for Pipkin type IV FH fracture.
皮普金IV型股骨头（FH）骨折被认为预后较差。对于这种复杂骨折有多种手术入路和治疗方法。然而，没有一种治疗方法优于另一种。我们回顾了一系列通过改良吉布森入路接受手术治疗的皮普金IV型FH骨折患者。
我们回顾了2012年至2013年间连续9例通过改良吉布森入路接受手术治疗的皮普金IV型FH骨折患者。详细描述了手术过程，并对影像学结果和功能结果进行了回顾。
平均随访时间为17（12 - 30）个月。平均梅勒·达布尼评分是16（8 - 19）。根据马塔分级，7例患者实现了解剖复位，2例复位欠佳。随访期间无早期创伤性骨关节炎发生。1例患者在初次手术后3个月出现早期创伤性股骨头坏死，接受了全髋关节置换术。
通过这种手术入路固定FH和髋臼，影像学和功能结果均令人满意。我们仍需要更多患者进行前瞻性研究，以找到治疗皮普金IV型FH骨折的最佳手术入路。
