Pipkin骨折术后髋关节功能恢复影响因素分析

ANALYSIS OF INFLUENCING FACTORS OF HIP FUNCTIONAL RECOVERY AFTER Pipkin FRACTURE SURGERY

目的探讨影响Pipkin骨折术后髋关节功能恢复的因素。方法回顾分析2002年5月-2009年2月收治的37例Pipkin骨折患者临床资料。男32例,女5例;年龄26～98岁,中位年龄43岁。致伤原因:交通事故伤31例,摔伤4例,高处坠落伤2例。受伤至手术时间1～28 d,平均8.6 d。骨折根据Pipkin分型标准:Ⅱ型23例,Ⅲ型8例,Ⅳ型6例。27例采用切开复位内固定(open reduction and internal fixation,ORIF),10例行人工全髋关节置换(totalhip arthroplasty,THA)。对性别、年龄、受伤至手术时间、骨折类型、治疗方式与术后髋关节功能恢复相关关系进行统计学分析。结果术后患者切口均Ⅰ期愈合,无感染及下肢深静脉血栓形成发生。患者均获随访,随访时间10～94个月,平均40.5个月。X线片复查ORIF患者骨折于术后5～11个月达骨性愈合,平均8.9个月;THA患者无假体松动、下沉。末次随访时牛津髋关节评分标准(OHS)评分为16～58分,平均37.2分;获优12例,良13例,可2例,差10例。单因素分析表明,骨折类型及治疗方式对术后髋关节功能恢复有显著影响,差异有统计学意义(P<0.05)。多因素分析表明,骨折类型及治疗方式对术后髋关节功能恢复影响无统计学意义(P>0.05)。结论 Pipkin骨折分型及治疗方式可能影响Pipkin骨折术后髋关节功能恢复,术前应根据骨折分型选择恰当治疗方式以保证关节功能恢复。

Objective To investigate the influencing factors of the hip functional recovery after Pipkin fracture surgery.Methods The clinical data were retrospectively analysed,from 37 patients with Pipkin fracture between May 2002 and February 2009.There were 32 males and 5 females,aged 26 to 98 years（median,43 years）.The causes of injury were traffic accident in 31 cases,a falling in 4 cases,and falling from height in 2 cases.The time from injury to operation was 1-28 days（mean,8.6 days）.According to the Pipkin classification criteria,there were 23 cases of type II,8 cases of type III,and 6 cases of type IV.Open reduction and internal fixation（ORIF） were performed in 27 cases,total hip arthroplasty（THA） in 10 cases.The relationships between gender,age,time from injury to surgery,type of fracture,treatment way and the hip functional recovery were analysed statistically.Results All patients achieved healing of incision by first intention,no infection and deep venous thrombosis occurred.All patients were followed up 10 to 94 months with an average of 40.5 months.Bone fusion was observed at 5-11 months（mean,8.9 months） in patients undergoing ORIF by X-ray examination;no prosthetic loosening or subsidence occurred in patients undergoing THA.At last follow-up,Oxford Hip Score（OHS） was 16-58 points（mean,37.2 points）;the results were excellent in 12 cases,good in 13 cases,fair in 2 cases,and poor in 10 cases.The univarible analysis showed that the type of fracture and treatment way significantly affected the hip functional recovery（P 0.05）.The multivarible analysis showed that the type of fracture and treatment way had no significant effect on the hip functional recovery（P 0.05）.Conclusion Type and treatment way of Pipkin fracture may affect postoperative hip function recovery,so appropriate treatment should be selected based on fracture type to ensure the restoration of joint function.