【摘要】 目的探讨股骨头骨折合并髋臼骨折的外科治疗方式并进行疗效分析。方法回顾性分析2000年5月—2010年8月脊柱外科收治的12例股骨头骨折合并髋臼骨折的病例,髋臼骨折按Judet-Letournel分型,简单骨折10例,复杂骨折2例;股骨头骨折按Yoon’s分类方法,Ⅱ型和Ⅲ型共9例,其余均为Ⅳ型,受伤至手术时间为7~10 d,平均8 d,均采用改良的髋关节后外侧入路手术治疗。其中3例Ⅳ型股骨头骨折患者因股骨头呈粉碎状态无法复位固定直接采用全髋关节置换术,髋臼侧骨折复位后行钢板内固定;其余Ⅱ、Ⅲ型股骨头骨折患者采用切开复位螺钉内固定,其中早期5例采用4.5 mm皮质骨螺钉内固定并埋头,骨折愈合后取出金属内固定螺钉时非常困难而且创伤大存在股骨头坏死的风险,后期内固定物采用可吸收螺钉和(或)骨钉固定,避免二次创伤带来的并发症,髋臼骨折复位后通常采用重建钢板内固定,术后给予下肢外展中立位持续皮牵引,术后4周开始功能康复锻炼,3个月后逐渐开始部分负重活动。结果 12例患者获得6~60个月的随访,采用Epstein评价方法,优2例,良7例,可2例,差1例。结论Ⅱ、Ⅲ型损伤应早期切开复位,行螺钉内固定术,对于Ⅳ型骨折,选择全髋关节置换术是一种比较好的治疗方法。更多还原

【Abstract】 Objective To investigate the surgical treatment of acetabular fracture with femoral head fractures and efficacy analysis was conducted. Methods A retrospective analysis of our hospital from May 2000 to Aug 2010 was performed. 12 cases of acetabular fracture with femoral head fracture cases,12 cases of acetabular fracture the the Judet-Letournel genotyping,simple fracture 10 cases of complex fractures,femoral head fractures by Yoon. s classification the parting III 9 cases,and the rest were Ⅳ injury to surgery time was 7- 10 days,with an average of eight days,improved hip posterolateral approach surgical treatment. 3 cases with type Ⅳ femoral head fractures in patients were treated with total hip arthroplasty,acetabular fractures underwent internal plate fixation;9 cases Ⅱ,Ⅲ type femoral head fractures were treated with screw fixation,early five cases with 4. 5 mm cortical bone screws and countersunk,which were very difficult to be removed,the patients must be endured traumatic osteonecrosis risk;4 cases with absorbable screws or bone nails,which avoided secondary trauma complications,after surgery all patients were handled with lower limb abduction and neutral position by skin traction,after 4 weeks rehabilitation exercises began,after 3 months gradually began partial weight-bearing activities. Results 12 patients were followed up 6- 60 months. Epstein evaluation methods,excellent in 2 cases,better in 7cases,good in 2 cases,and poor in 1 case. Conclusion To Ⅲ injuries,open reduction and the line screw fixation should be performed early,total hip replacement surgery was a good treatment for Ⅳ fractures.更多还原