【摘要】 目的探讨髋关节后脱位合并股骨头骨折的治疗方法与愈后。方法分析29例髋关节后脱位合并股骨头骨折患者的分型、治疗时间及治疗方式。27例获得随访(93.1%),随访时间1～15年(平均7年)。以X光平片及髋关节功能恢复情况评价其愈后。结果29例髋关节后脱位合并股骨头骨折患者按Pipkin分类法分型,Ⅰ型13例(占44.8%),Ⅱ型9例(占31%),Ⅲ型3例(占10%),Ⅳ型4例(占14.2%),对27例获得随访者按HHS(HarrisHipScore)功能评价标准,Ⅰ型中优为9例(占33.3%),良2例(占7.4%),可1例(占3.7%),差0例(占0%),Ⅱ型中优为0例(占0%),良2例(占7.4%),可4例(占14.9%),差2例(占7.4%),Ⅲ型中优1例(占3.7%),良0例(占0%),可1例(占3.7%),差1例(占3.7%),Ⅳ型中优0例(占0%),良2例(占7.4%),可1例(占3.7%),差1例(占3.7%),其中行人工全髋关节置换者4例(占总例数13.7%)。结论髋关节后脱位合并股骨头骨折的治疗方法应根据损伤机制、骨折脱位类型确定。其愈后取决于患者的年龄、治疗时间、骨折脱位类型、治疗方法以及预防并发症的相关措施。更多还原

【Abstract】 Objective To discuss the treatment method and prognosis of posterior hip dislocation combined with femoral fractures. Methods Twenty nine patients who had been diagnosed as cases of posterior hip dislocation combined with femoral head fracture were reviewed, with their type of fracture, timing of treatment and method of treatment analyzed. Twenty seven (93.1%) of the 29 cases were followed up from 1987 to 2002 for an average period of seven years. Their prognosis was evaluated according to the x ray radiography and the function of hip joints. Results According to Pipkin IV classification, 13 cases were Pipkin Ⅰ(44.8%), 9 cases Pipkin Ⅱ(31%), 3 cases Pipkin Ⅲ(10%), and 4 cases Pipkin Ⅳ(14.2%). In type I, 9 cases were rated as excellent (33.3%), 2 good (7.4%), 1 fair (3.7%) and 0 poor (0%) by Harris hip score. In typeⅡ, 0 case was rated as excellent (0%), 2 cases good (7.4%), 4 fair (14.9%) and 2 poor (7.4%). In type Ⅲ, 1 case was rated as excellent, 0 good (0%), 1 fair (3.7%) and 1 poor (3.7%). In type Ⅳ, 0 case was rated as excellent (0%), 2 good (7.4%), 1 fair (3.7%) and 1 poor (3.7%). In all the 29 cases, those which needed total hip arthroplasty (THA) were four (13.7%). Conclusions The choice of treatment method should be determined by the mechanism of injury and the type of fracture. The factors ensuring a satisfactory prognosis are: (1) The age of the patients should be younger than 40 years. (2) Since a timely reduction can prevent the onset of avascular necrosis of femoral head, it should be finished within 12 hours after the injury, and the fixation should be done within 10 days. (3) In all types, early reduction of hip dislocation, early stabilization, anatomic reduction of the fracture should be achieved. (4) The prevention of possible complications should be taken into serious consideration.更多还原