髋关节后脱位伴股骨头骨折的临床治疗

Clinical treatment of posterior hip dislocation combined with femoral fractures

目的：探讨髋关节后脱位合并股骨头骨折的治疗方法与愈合评价。方法分析16例髋关节后脱位合并股骨头骨折患者的分型、治疗时间及治疗方式。随访时间3～8年（平均4年）。以影像学检查及髋关节功能恢复情况评价其愈后。结果16例髋关节后脱位合并股骨头骨折患者按Pipkin分类法分型，Ⅰ型：髋关节后脱位伴股骨头中央凹尾端的骨折，12例（占75．0％）；Ⅱ型：髋关节后脱位伴股骨头中央凹头端的骨折，3例（占18．8％）；Ⅲ型：Ⅰ型或Ⅱ型骨折伴股骨颈骨折，0例（占0％），Ⅳ型：Ⅰ型、Ⅱ型或Ⅲ型骨折伴髋臼骨折，1例（占6．3％）。对16例获得随访者按HHS（HarrisHipScore）功能评价标准，Ⅰ型中效果优为9例，良2例，差1例，Ⅱ型中效果优为1例，良1例，差1例，Ⅳ型中效果可1例。结论髋关节后脱位合并股骨头骨折的治疗方法应根据损伤机制、骨折脱位类型确定，其中对于PipkinⅠ型骨折可予以闭合复位后牵引治疗，而对于PipkinⅡ型或Ⅲ型骨折手术治疗是较为理想的选择。

Objective To discuss the treatment method and prognosis of posterior hip dislocation combined with femoral fractures .Methods Twenty-nine patients who had been diagnosed as cases of posterior hip dislocation combined with femoral head fracture were reviewed , with their type of fracture , timing of treatment and method of treatment analyzed .16 cases were followed up from 2003 to 2011 for an average period of 6 years. Their prognosis was evaluated according to the x-ray radiography and the function of hip joints .Results According to Pipkin classification , 12 cases were PipkinⅠ, 3 cases PipkinⅡ, 0 cases PipkinⅢ（10%） , and 1 cases Pipkin Ⅳ.In type I, 9 cases were rated as excellent , 2 good, and 1 poor by Harris hip score .In typeⅡ, 1case was rated as excellent , 1case good , and 1 poor.In type Ⅳ , 1 fair .Conclusions The choice of treatment method should be determined by the mechanism of injury and the type of fracture .