Pipkin骨折17例外科手术疗效

Clinical efficacy of surgical treatment for Pipkin fracture in 17 cases

目的:探讨髋关节脱位合并股骨头骨折(Pipkin骨折)手术治疗的效果。方法:回顾性分析17例Pipkin骨折患者外科治疗的临床资料,受伤至手术时间1~30(平均9.5) d。按Pipkin分型,Ⅰ型4例,Ⅱ型6例,Ⅲ型1例,Ⅳ型6例。13例入院后予以皮牵引或骨牵引,术后持续牵引4周。结果:17例患者的随访时间为8~84(平均43)个月。所有患者无伤口感染、皮瓣坏死及内植物松动、断裂等。随访时按照Thompson-Epstein评价系统评价关节功能,Ⅰ型中优3例,可1例;Ⅱ型中获优3例,良2例,差1例;Ⅲ型1例为良;Ⅳ型中获2例,良2例,可2例;优良率为76.47%。结论:Pipkin骨折早期诊断并根据Pipkin分型合理选择手术入路及内固定方式,有助于患者获得满意的髋关节功能并改善预后。

Objective:To investigate the clinical effect of surgical treatment for femoral head fracture-dislocation (Pipkin fracture).Methods:A total of 17 patients with femoral head fracture-dislocation were retrospectively analyzed.The duration from injury to surgery was 1–30 (average 9.5) days.According to the classification of Pipkin criteria,there were 4,6,1,and 6 cases in Type Ⅰ,Type Ⅱ,Type Ⅲ,and Type Ⅳ,respectively.Thirteen patients were treated with skin traction or bone traction after admission,and the postoperative traction lasted for 4 weeks.Results:All patients got a mean follow-up of 43(8–84) months.No patient suffered from infection and skin flap necrosis.X ray showed no implants loose or breakage.According to the Thompson-Epstein evaluation system,among the cases of Type Ⅰ,3 cases were excellent and 1 case was fair;among the cases of Type Ⅱ,3 cases were excellent,2 cases were good,and 1 case was poor.The case of Type Ⅲ was good.Among the cases of Type Ⅳ,2 cases were excellent,2 cases were good,and 2 cases were fair.The excellent and good rate was 76.47%.Conclusion:Early diagnosis of Pipkin fracture,reasonable selection of surgical approach and internal fixation according to Pipkin classification can help patients to obtain satisfactory hip function and improve their prognosis.