外固定架在治疗陈旧性髋关节脱位中的预复位作用

Pre-reduction effect of external fixator in treatment of obsolete dislocation of hip joint

目的 探讨外固定架在陈旧性髋关节脱位中预复位的应用价值。方法 回顾性分析2010年1月至2017年1月于我院应用外固定架治疗的陈旧性髋关节脱位9例患者,其中男6例,女3例;年龄19-47岁,平均（32.0±8.3）岁;受伤至手术时间3-9个月,平均（6.2±1.9）个月。记录患者肢体短缩长度,牵引时间,牵引长度,手术时间,手术出血量,术前与末次随访视觉模拟评分（visual analogue scale,VAS）、Epstein评分、D’Aubigne 功能评分等进行疗效和功能评价。结果 本组9例均顺利完成手术,患侧下肢短缩5-11 cm,平均（6.7±2.0） cm;术前牵引时间20-45 d,平均（26.9±8.2） d;牵引长度5-12 cm,平均（7.1±2.2） cm。二期重建复位手术时间2.0-4.0 h,平均（2.8±0.7） h;手术出血量800-2 000 ml,平均（1 216.7 ±422.8） ml。至末次随访,本组9例Epstein评分：优4例,良4例,改善1例,优良率为88.89%。术前VAS评分（0.9±0.8）分,末次随访为（4.6±0.9）分,术前术后两者比较差异有统计学意义（t=8.981,P=0.000）;术前D’Aubigne 功能评分为（5.2±1.0）分,末次随访为（13.1±2.0）分,差异有统计学意义（t=-12.044,P=0.000）。结论 外固定架在陈旧性髋关节脱位治疗中有助于股骨头复位,患者便于携带牵引,方便功能锻炼,容易接受,依从性强;术者应用操作简单灵活,牵引作用力强,股骨头复位效果明显,简化了手术方式,提高了复位效果。

Objective To explore the application value of external fixator in obsolete hip dislocation. Methods Retrospective analysis of 9 cases of obsolete hip dislocation treated with external fixator from January 2010 to January 2017. There were 6 males and 3 females, with an average of 32.0±8.3 years old （range 19-47）. The time from injury to operation was 3-9 months, with an average of 6.2±1.9 months. The patient＇s limb shortening length, traction time, traction length, operation time, surgical bleeding volume, preoperative and last follow-up VAS score, Epstein score, D＇Aubigne functional score were recorded. Results The length of the limb shortened 5-11cm, with an average of 6.7±2.0 cm. The preoperative traction time ranged 20-45 d, with an average of 26.9±8.2 d. The length of traction ranged 5-12 cm, with an average of 7.1±2.2 cm. The second reconstruction operation time was 2.0-4.0 hours, with an average of 2.8±0.7 h. The bleeding volume was 800-2 000ml, with an average of 1 216.7±422.8 ml. The Epstein score at the last follow-up was excellent in 4 cases, good in 4 cases and improved in 1 case. The preoperative VAS score and the final follow-up VAS score were 0.9±0.8 points and 4.6±0.9 points respectively. There was a significant difference between preoperative and postoperative VAS scores （t=8.981, P=0.000）. The D＇Aubigne functional scores of preoperative and final follow-up were 5.2±1.0 points and 13.1±2.0 points respectively and the difference was statistically significant （t=-12.044, P=0.000）. Conclusion The external fixation in the treatment of obsolete dislocation of the hip is helpful and accepted in patients with femoral head dislocation. It is easy to carry and tract for patients and convenient for functional exercise. The external fixation makes operation simple and flexible; the traction force is strong and the effect of the femoral head reduction is obvious, the operation method is simplified and the quality of the reduction is improved.