Ganz入路与S-P入路治疗PipkinⅠ和Ⅱ型股骨头骨折的对比分析

Comparison of Ganz approach and S-P approach in the treatment of Pipkin type Ⅰ and Ⅱ femoral neck fractures

目的比较Ganz入路与S-P入路治疗PipkinⅠ和Ⅱ型股骨头骨折的临床疗效。方法回顾性分析2013年1月—2017年4月惠州市中心人民医院、惠州市博罗县杨桥卫生院以及惠州市第一人民医院收治的PipkinⅠ或Ⅱ型股骨头骨折患者29例,其中采用Ganz入路12例,男性10例,女性2例,年龄15~70岁,平均36.83岁;致伤原因:道路交通伤9例,高空坠落伤3例。S-P入路17例,男性15例,女性2例;年龄17~73岁,平均37.53岁;致伤原因:道路交通伤13例,高空坠落伤4例。比较两组患者手术时间、术中出血量、术前术后血红蛋白的差值ΔHGB、末次随访时Thompson-epstein评分的差异,统计分析两组患者术后下肢深静脉血栓、股骨头坏死、异位骨化及截骨片延迟愈合发病率。结果两组患者手术时间及手术出血量差异无统计学意义(P>0.05),Ganz组与S-P组ΔHGB分别为(17.01±4.18)、(11.35±4.32)g/L,差异有统计学意义(P<0.05)。Ganz组随访(17.75±3.49)个月,S-P组随访(18.71±4.04)个月,两组末次随访Thompson-epstein评分优良率差异无统计学意义。术后两组患者下肢深静脉血栓、股骨头坏死、异位骨化的发病率相似,差异无统计学意义,Ganz组发生1例截骨片延迟愈合。结论S-P入路和Ganz入路均能充分暴露术野,有效治疗PipkinⅠ、Ⅱ型骨折,术后疗效及并发症发生率相似;Ganz入路隐性失血较多,且存在截骨片延迟愈合的风险。

Objective To compare the clinical efficacy and postoperative complications between Ganz approach and S-P approach in the treatment of type Ⅰ/Ⅱ Pipkin fracture.Methods Clinical data of 29 cases with type Ⅰ/Ⅱ Pipkin fracture was analyzed retrospectively.All cases were treated in Huizhou Minicipal Central Hospital,Yangqiao Town Health Center or Huizhou First People's Hospital from Jan.2013 to Apr.2017.Among them,12 cases were treated with Ganz approach,including 10 males and 2 females.Their age ranged from 15 to 70 years,with an average age of 36.83 years.There were 9 cases of traffic accidents and 3 cases of high altitude fall injuries.There were 17 cases of S-P approach,including 15 males and 2 females.Their age ranged from 17 to 73 years,with an average age of 37.53 years.There were 13 cases of traffic accidents and 4 cases of high altitude fall injuries.The differences in the operation time,intraoperative blood loss,reduction of hemoglobin and the follow-up Thompson-epstein score were statistically analyzed between the two groups.Morbidity of deep venous thrombosis of the lower limbs,femoral head necrosis,heterotopic ossification and the delayed union of the trochanter were compared.Results The operation time and intraoperative blood loss of the two groups had no significant difference ( P >0.05),but reduction of hemoglobin in the Ganz group was higher than that of the S-P group (17.01±4.18 vs 11.35±4.32).The follow-up time was (17.75±3.49) months in the Ganz group and (18.71±4.04) months in the S-P group.The difference was statistically significant( P <0.05).One case of delayed union of trochanter was found in the Ganz group.The excellent and good rate of postoperative Thompson-epstein score had no statistical difference between the two groups in the last follow-up time.The incidence of deep venous thrombosis,femoral head necrosis and heterotopic ossification was similar.Conclusion S-P approach and Ganz approach were all able to fully expose the operation field and treat PipkinⅠand Ⅱ fractures effectively.The outcomes and complications of the two approaches were similar,but there was a risk of delayed union of trochanter with Ganz approach,and more hidden hemorrhage was observed in the Ganz group.