改良Smith—Petersen入路不切断股直肌治疗PipkinⅠ、Ⅱ型骨折

Treatment of Pipkin types Ⅰ ＆ Ⅱ fractures via the modified Smith-Petersen approach without discon- necting the rectus femoris

目的探讨改良Smith．Petersen（S—P）入路不切断股直肌治疗PipkinⅠ、Ⅱ型骨折的临床疗效。方法回顾性分析2007年1月至2015年4月收治的37例PipkinⅠ、Ⅱ型骨折患者资料。所有患者根据手术入路不同分为2组：改良入路组16例，男12例，女4例；平均年龄为（42．3±11．2）岁；骨折按Pipkin分型：Ⅰ型13例，Ⅱ型3例；采用改良s．P入路不切断股直肌可吸收螺钉固定。常规入路组21例，男16例，女5例；平均年龄为（44.7±11．7）岁；骨折按Pipkin分型：Ⅰ型15例，Ⅱ型6例；采用传统S-P入路可吸收螺钉固定。比较两组患者的手术切口长度、手术时间、术中出血量，术后72h、4周及3个月疼痛视觉模拟评分（VAS），以及术后并发症发生率和末次随访时髋关节功能等。结果改良入路组与常规入路组患者术后分别获（16．94-6．9）、（17．24-5．1）个月随访。改良入路组患者的手术切口长度[（8．2±0．9）cm]显著短于常规入路组患者[（12．2±1．1）cm]，术中出血量[（145．0±17．4）mL]显著少于常规入路组患者[（161．2±20．5）mL]，术后72h及4周VAS评分[（4．6±1．2）、（1．7±0．8）分】显著低于常规入路组患者[（5．8±1．4），（2．3±0．9）分]，差异均有统计学意义（P〈0．05）。而两组患者的手术时间、术后3个月VAS评分、末次随访时髋关节功能优良率及并发症发生率比较差异均无统计学意义（P〉0．05）。结论改良S—P入路不切断股直肌具有创伤小、显露清晰及早期功能恢复快等优点，是治疗PipkinⅠ、Ⅱ型骨折的一种较好手术入路选择。

Objective To investigate the clinical results of treating Pipkin types Ⅰ ＆ Ⅱ fractures via the modified Smith-Petersen approach without disconnecting the rectus femoris. Methods We retro- spectively reviewed 37 patients who had been treated for Pipkin types Ⅰ ＆ Ⅱ fractures between January 2007 and April 2015. They were divided into 2 groups according to the 2 surgical approaches used： modified and conventional Smith-Petersen ones. In the modified approach group of 16 cases, there were 12 males and 4 females, with an average age of 42.3± 11.2 years, and 13 cases of Pipkin type I and 3 cases of Pipkin type I1. In the conventional approach group of 21 cases, there were 16 males and 5 females, with an average age of 44. 7 ± 11.7 years, and 15 cases of Pipkin type Ⅰ and 6 cases of Pipkin type Ⅱ. The 2 groups were compared in terms of incision length, operation time, bleeding, visual analogue scale （VAS） score at 72 hours, 4 weeks and 3 months after surgery, hip joint function by Thompson-Epstein score at the final follow-up and postoperative complications. Results The modified approach and conventional approach groups ob- tained an average follow-up of 16. 9 ± 6.9 months and 17.2 ± 5.1 months, respectively. The modified group had significantly shorter incision length （8.2 ± 0.9 cm）, significantly less intraoperative blood loss （145.0 ± 17.4 mL）, and significantly lower VAS scores at 72 hours and 4 weeks after surgery （4. 6 ± 1.2 ＆ 1.7 ± 0.8） than the conventional group [ 12. 2 ± 1.1 cm, 161.2 ± 20. 5 mL, （5.8 ± 1.4 ＆ 2.3 ± 0. 9）, respec- tively] （P 〈 0.05）. There were no statistical significant differences in operation time, VAS score at 3 months, good to excellent rate of hip function or complications （ P 〉 0. 05） . Conclusion Since the modified Smith-Petersen approach allows for minimal invasion, sufficient simultaneous exposure and rapid recovery of early hip function, it is a better choice for the treatment of Pipkin types Ⅰ ＆ Ⅱ fractures.