髋关节后脱位合并股骨头骨折手术疗效及并发症分析

Surgical outcome and complications of posterior hip dislocation combined with femoral head frac- tures

目的探讨髋关节后脱位合并股骨头骨折手术治疗的近期疗效和并发症。方法对1999年12月-2008年12月采用手术治疗的22例髋关节后脱位合并股骨头骨折患者进行回顾性分析，患者均为男性；年龄23～52岁，平均39．2岁。股骨头骨折根据Pipkin分类法分型：Ⅰ型9例（41％），Ⅱ型7例（32％），Ⅲ型2例（9％），Ⅳ型4例（18％）。分别采用不同的手术入路和治疗方式进行治疗，定期随访，以Harris评分和Thompson＆Epstein评分作为术后髋关节临床及影像学随访的评定标准，并对术后并发症进行分析。结果所有患者均获得随访，平均随访时间36个月。临床随访结果Harris评分：优10例，良7例，可2例，差3例，优良率为77％。并发症包括股骨头缺血性坏死4例，创伤性关节炎6例，无髋关节异位骨化发生。1例原发性坐骨神经损伤在术后1年逐渐恢复正常。结论髋关节后脱位合并股骨头骨折应尽早手术治疗，根据骨折类型选择合适的手术方式，减少并发症的发生。

Objective To investigate the short-term surgical effect and complications of posterior dislocation of the hip with femoral head fractures. Methods Twenty-two patients with posterior disloca- tion of the hip with femoral head fractures treated surgically from December 1999 to December 2008 were re- viewed retrospectively. All the patients were males aged from 23-52 years （ mean 39.2 years）. According to Pipkin classification, fractures were type Ⅰ in nine eases （41%）, type Ⅱ in seven （32%）, type Ⅲ in two （9%） and type Ⅳ in four （18%）. Different surgical approaches and treatment methods were employed to- gether with a periodic follow-up. Harris score and Thompson ＆ Epstein score were used as measurement standard in postoperative clinical and radiological follow-up. Postoperative complications were analyzed as well. Results All the patients were followed up for mean 36 months. Clinical outcome as assessed by Harris criteria was excellent in 10 cases, good in seven, fair in two and poor in three, with excellent-good rate of 77%. Complications included femoral head avascular necrosis in four cases and traumatic arthritis in six. Heterotopic ossification of the hip did not occur. One case complicated with idiopathic injury of sciatic nerve was recovered at one year after operation. Conclusions Posterior dislocation of the hip with femo- ral head fractures should be operated as soon as possible. Operational modalities should depend on the type of fractures for the sake of reducin~ comolications.