改良S-P入路不切断股直肌治疗股骨头骨折合并髋关节后脱位

Modified S-P approach in the treatment of femoral head fracture with posterior dislocation of hip joint

目的研究改良Smith-Petersen（S-P）入路不切断骨直肌治疗股骨头骨折合并髋关节后脱位的临床效果。方法纳入我院60例股骨头骨折合并髋关节后脱位患者作为研究对象，随机抽签分为两组，每组各30例。观察组行改良S-P入路，对照组行常规S-P入路。记录两组手术一般情况，比较两组术后疼痛状态、并发症及髋关节功能恢复情况。结果观察组术中出血量、切口长度、引流管拔除时间、术后首次下地活动时间及住院时间均显著低于对照组（P〈0.05）。观察组术后3 d、1周及4周VAS评分均显著低于对照组（P〈0.05）。观察组术后3个月髋关节功能显著优于对照组（P〈0.05）。观察组近远期并发症均低于对照组（P〉0.05）。结论改良S-P入路不切断骨直肌治疗股骨头骨折合并髋关节后脱位较常规入路有助于缩短术后髋关节功能恢复时间，且术后疼痛轻，并发症少，是PipkinⅠ、Ⅱ型骨折的首选手术方式。

Objective To study the clinical effect of modified S-P approach on the femoral head fracture with posterior dislocation of hip joint.MethodsSixty cases of femoral head fracture with posterior dislocation of hip joint in our hospital were randomly divided into two groups, with 30 cases in each group. The observation group underwent modified S-P approach, and the control group received conventional S-P approach. The general situation of the two groups was recorded, and the postoperative pain, complications and hip function recovery were compared.ResultsThe amount of intraoperative blood loss, incision length, drainage tube extraction time, the first time of ground movement after the operation and hospital stay in the observation group were significantly lower than those in the control group（P〈0.05）. The VAS scores of the observation group were significantly lower than that of the control group at 3 day 1 and 4 weeks after operation（P〈0.05）. The postoperative hip function in the observation group was significantly better than that in the control group after 3 months of operation（P〈0.05）. The near and long-term complications of the observation group were lower than those of the control group（P〉0.05）.ConclusionsThe modified S-P approach without cutting the bone for the treatment of femoral head fracture with rectus posterior dislocation of the hip compared with the conventional approach helps to shorten the time the recovery of hip function after surgery, the postoperative pain is mild and the complications is few. It is the first choice for Pipkin Ⅰ and Ⅱ fractures.