大转子截骨入路可吸收螺钉治疗股骨头骨折疗效分析

Treatment of femoral head fractures(Pipkin Ⅰ, Ⅱ) using trochanteric osteotomy approach for bio-absorbable screw fixation

[目的]评估经大转子截骨入路可吸收螺钉固定治疗Pipkin I、II型股骨头骨折的中远期疗效。[方法]回顾性分析经大转子截骨入路可吸收螺钉治疗髋关节后脱位合并Pipkin I、II型股骨头骨折患者28例,男19例,女9例,平均年龄(41.54±2.51)岁(26~56岁);Pipkin I型17例,Pipkin II型11例,收集手术时间、术中出血量、股骨头坏死及异位骨化发生例数,功能评分采用Harris评分、改良Merle d’Aubigne-Postel评分,影像学评分采用Thompson-Epstein评分。[结果]1例女性及1例男性患者因失访从研究中剔除,剩余26例平均随访时间(35.42±1.63)个月(13~78个月),平均手术时间(1.35±0.45)h(0.85~1.84 h),平均术中出血量(237.41±35.25)ml(194~279 ml),截止末次随访,未出现异位骨化或股骨头缺血性坏死、髋关节脱位及坐骨神经症状。末次随访Harris评分平均(84.43±2.19)分,优良率为88.41%;改良Merle d’Aubigne-Postel评分(15.34±1.21)分,优良率为92.3%;Thompson-Epstein评价结果显示,优良率达88.47%(10例优,13例良,3例一般)。[结论]经大转子截骨入路对Pipkin I、II型股骨头骨折进行可吸收螺钉内固定术是一种有效的手术方法。

[Objective] To investigate the effectiveness of surgical treatment for Pipkin type I, II femoral head fractures using bioabsorbable screws via trochanteric osteotomy approach. [Methods] Twenty-eight patients who suffered from posteri- or dislocation of hip joint combined with Pipkin type I and II femoral head fractures were enrolled into this retrospective evaluation, including 19 males and 9 females with an average age of （41.54±2.51） （range, 26-56）. Of them, 17 patients were diagnosed as Pipkin type I and the remaining 11 as type II of femoral head fracture. All patients underwent fixation of femoral head fractures with bio-absorbable screw via trochanteric osteotomy. Clinical data were documented and evaluated. [Results] The mean operation time was （1.35±0.45） hours （range, 0.85 ± 1.84 h）, mean intra-operational blood loss was （237.41±35.25） ml （range, 194±279ml）. One female and one male were exctuded due to lost to follow-up, and the remaining 26 patients were included into the final evaluation with an average follow-up time of 35.42 ± 1.63 months （range, 13±78 months） . There were no occurrence of HO, ANFH, post-operational hip dislocation or sciatic nerve symptoms in any of them during the follow-up period. At the last follow-up, the mean Harris score was 84.41 ±2.19, with 88. 41% of good-to-excellent result, additionally the mean modified Merle d＇ Aubigne-Postel scale was 15.34± 1.21, with 92.33% of good-to-excellent result, furthermore Thompson-Epstein radiographic evaluation showed 88.47% of goodto-excellent result as well. [Conclusion] The results demonstrated that, with regarding to the Pipkin type I and Pipkin type II femoral head fracture, internal fixation with ab- sorbable screws via trochanteric osteotomy approach is an effective surgical method.