10例股骨头骨折患者治疗的临床疗效和预后分析

Clinical effect and prognosis analysis of 10 patients with femoral head fracture

目的股骨头骨折是一种常伴有不良预后的少见损伤。本研究回顾性分析笔者所在医院收治的10例股骨头骨折患者,并对临床疗效和预后进行了评估和分析。方法我们回顾性分析了2012年1月—2022年12月期间于我院诊治的股骨头骨折患者10例。男性8例(80%),女性2例(20%),平均年龄为46.4岁。根据Pipkin的分类,PipkinⅠ型5例,PipkinⅡ型2例,PipkinⅢ型1例,PipkinⅣ型2例。治疗方法分为非手术、手术切开复位内固定术和全髋关节置换术(Total Hip Replacement,THR)三种。术后随访时间平均13个月,我们记录了相关的并发症,并使用改良Harris髋关节评分(Modifed Harris Hip Score,MHHS)评估髋关节功能情况。结果10例患者,5例进行了保守治疗,5例进行了手术治疗,其中1例进行了THR手术治疗。在随访过程中,10例患者4例获得了骨折处良好的愈合,均为PipkinⅠ型股骨头骨折保守治疗患者。1例保守治疗患者并发了髋部创伤性骨关节炎,1例患者复查过程中并发了股骨头坏死,1例患者术后并发了坐骨神经损伤合并手术切口浅层感染,经过治疗后好转,6个月后并发了髋部创伤性关节炎,1例患者并发了创伤性关节炎合并异位骨化,1例患者并发了异位骨化。MHHS评分临床结果为优3例(30%),良3例(30%),一般2例(20%),差2例(20%)。1例预后不佳的患者发展为股骨头坏死后于他院进行了THR手术治疗。结论我们的回顾性分析结果表明,股骨头骨折通常是预后较差的一种骨折类型,目前针对其治疗仍无统一的标准,同时预后仍存在股骨头坏死、创伤性关节炎和异位骨化等并发症可能,随着Pipkin分型从I到IV型,并发症及不良预后发生率逐渐增高。

Objective Femoral head fracture is a rare injury with poor prognosis.In this study,10 patients with femoral head fracture admitted to the hospital of the authors were retrospectively analyzed,and the clinical efficacy and prognosis were evaluated and analyzed.Methods We retrospectively analyzed 10 patients with femoral head fracture who were diagnosed and treated in our hospital from January 2012 to December 2022.There were 8 males(80%)and 2 females(20%)with an average age of 46.4 years.According to the classification of Pipkin,there were 5 cases of Pipkin type I,2 cases of Pipkin type II,1 case of Pipkin type III,and 2 cases of Pipkin type IV.The treatment options were non-surgical,surgical open reduction and internal fixation,and Total Hip Replacement(THR).During a mean follow-up of 13 months,associated complications were recorded and Hip function was assessed using the Modifed Harris Hip Score(MHHS).Results Of the 10 patients,5 underwent conservative treatment,5 underwent surgical treatment,and 1 underwent THR surgery.During follow-up,4 out of 10 patients achieved good healing at the fracture site,all of whom were treated conservatively with Pipkin type I femoral head fracture.Traumatic osteoarthritis of the hip was complicated in 1 patient with conservative treatment.Necrosis of the femoral head was complicated in 1 patient during reexamination.Sciatic nerve injury combined with superficial incision infection was complicated in 1 patient after surgery,which was improved after treatment.Traumatic arthritis of the hip was complicated in 1 patient with ectopic ossification 6 months later.One patient developed ectopic ossification.The clinical results of MHHS score were excellent in 3 cases(30%),good in 3 cases(30%),average in 2 cases(20%)and poor in 2 cases(20%).One patient with poor prognosis developed necrosis of the femoral head and underwent THR surgery in another hospital.Conclusion Our retrospective analysis results show that femoral head fracture is usually a type of fracture with poor prognosis,and there is still no unified standard for its treatment.Meanwhile,the prognosis is still possible for complications such as femoral head necrosis,traumatic arthritis and ectopic ossification.With the classification of Pipkin from type I to type IV,the incidence of complications and poor prognosis is gradually increasing.