髋臼骨折合并股骨头损伤的诊治

Diagnosis and treatment of acetabular fractures combined with femoral head injury

目的评价股骨头损伤对髋臼骨折诊治的影响。方法对2001年7月～2005年7月收治的59例60侧合并有股骨头损伤的髋臼骨折患者进行回顾性分析；股骨头损伤分为劈裂骨折（Pipkin型）和压缩骨折，压缩骨折需经CT确诊；60例髋臼骨折中，56例行钢板螺钉内固定；而20侧股骨头劈裂骨折中，内固定7侧，切除4侧，余9侧未做处理；40例股骨头压缩骨折未予任何处理。结果29例手术患者获得平均35．4个月（15～60个月）随访；临床结果采用改良的d’Aubigne Postel评分标准。新鲜髋臼骨折中，对于合并的股骨头劈裂骨折，有移位而未手术处理的结果均不满意；对于合并的股骨头压缩骨折，涉及负重区的满意率为25．0％。结论髋臼骨折合并股骨头损伤的发生率较高，可影响预后；对于股骨头劈裂骨折，治疗髋臼骨折的同时应积极手术处理。

Objective To evaluate the impact of combined injury of femoral head on the clinical outcome of treatment of acetabular fractures. Methods A retrospective analysis was conducted for the 60 sides of acetabular fracture combined with femoral head injury which had been treated from July 2001 to July 2005 in our department. The femoral head injury included split fractures and compression fractures. The diagnosis of the latter was confirmed by CT scan. Twenty-nine patients were followed up for a mean period of 35.4 months （15 to 60 months）. Their clinical results were evaluated with the modified d＇Aubigne and Postel grading system. Results The results were unsatisfactory for all the fresh acetabular fractures combined with displaced split fracture of femoral head when no surgical treatment was conducted. The satisfactory rate was 25.0% for the compression fractures involving the weight-bearing area of the femoral head. Conclusions The incidence of combined femoral head injury is high in acetabular fractures and may have obvious impact on the clinical outcome. The displaced split fracture should be managed operatively in the simultaneous treatment of the acetabular fractures.