髋臼骨折合并同侧股骨头骨折的治疗策略及疗效

Treatment strategies and their effect for acetabular fractures combined with ipsilateral femoral head fractures

目的探讨髋臼骨折合并同侧股骨头骨折的治疗策略并分析其疗效。方法选择2006年1月_2012年6月收治的35例髋臼骨折合并同侧股骨头骨折患者，其中男31例，女4例；年龄19～53岁，平均35．3岁。采用非手术和切开复位内固定（openreductionandinternalfix—ation，ORIF）治疗。应用Harris评分评价髋关节功能恢复情况，记录患者并发症。结果27例患者获12—84个月随访，平均36．6个月。髋关节Harris评分37—98分，平均80．2分。结果优11例，良6例，可4例，差6例，优良率为63％。4例发生股骨头缺血坏死（15％），2例出现异位骨化（7％）。结论髋臼骨折合并同侧股骨头骨折预后较差，若髋臼后壁骨折面积〉40％、移位〉2mm，股骨头骨折面积〉20％，应行ORIF，可在一定程度上改善预后。

Objective To investigate the strategies for treatment of acetabular fractures combined with ipsilateral femoral head fractures and discuss their effect. Methods The study enrolled 35 cases of acetabular fractures combined with ipsilateral femoral head fractures admitted from January 2006 to June 2012. There were 31 males and 4 females, at an average age of 35.3 years （range, 19-53 years）. Non- surgical treatment and open reduction and internal fixation （ORIF） were performed. Harris hip function and postoperative complications were recorded at follow-up. Results Twenty-seven cases were followed up for a mean period of 36.6 months （ range, 12-84 months）. Mean Harris hip score was 80.2 points （range, 37-98 points）. The results were excellent in 11 cases, good in 6, fair in 4 and poor in 6, with the excellence rate of 63%. Femoral head necrosis occurred in 4 cases （ 15% ） and heterotopic ossifica- tion in 2 （7%）. Conclusion Acetabular fractures combined with ipsilateral femoral head fractures have poor outcomes, for which involvement of posterior wall for 〉 40% or displacement for 〉 2 mm and involvement of femoral head for 〉 20%, ORIF is necessary and in part may improve the outcome.