大转子截骨入路与K-L后侧入路治疗PipkinⅣ型骨折疗效分析

Analysis of effectiveness of greater trochanteric osteotomy approach and K-L posterior approach in patients with typeⅣPipkin fracture

目的探讨两种手术入路治疗中青年PipkinⅣ型骨折的临床疗效。方法回顾分析2013年7月—2018年6月手术治疗的15例PipkinⅣ型骨折患者临床资料,根据手术入路不同分为A组(8例,采用K-L后侧入路)和B组(7例,采用大转子截骨入路)。两组患者性别、年龄、致伤原因、受伤至手术时间等一般资料比较,差异均无统计学意义(P>0.05)。记录两组患者切口长度、手术时间、术中出血量、住院时间、骨折愈合时间及并发症发生情况,根据Thompson-Epstein功能评价系统评定患者髋关节功能恢复情况。结果术后15例患者均获随访,随访时间1~5年,平均2.5年。两组患者手术时间比较差异无统计学意义(t=14.681,P=0.100);A组手术切口长度、术中出血量及骨折愈合时间均大于B组,住院时间短于B组,差异均有统计学意义(P<0.05)。A组术后1例发生髋关节疼痛、跛行和活动受限,1例骨化性肌炎,1例股骨头坏死,1例切口脂肪液化,1例坐骨神经痛,并发症发生率为62.5%;B组术后1例发生髋关节疼痛,2例骨化性肌炎,并发症发生率42.9%;两组并发症发生率比较差异无统计学意义(χ^2=-0.735,P=0.462)。末次随访时根据Thompson-Epstein功能评价系统评定,A组获优3例、良2例、可2例、差1例,优良率62.5%;B组获优4例、良2例、可1例,优良率85.7%;两组优良率比较差异无统计学意义(χ^2=-0.990,P=0.322)。结论K-L后侧入路术中骨折处理更加简便,但创伤较大,对血管损伤较大,失血量较多。大转子截骨入路能更好保护股骨头血供,手术时间较短,术中失血及并发症较少,是较为理想的PipkinⅣ型骨折手术治疗方式。

Objective To investigate the effectiveness of two surgical approaches in the treatment of typeⅣPipkin fracture.Methods The clinical data of 15 patients with typeⅣPipkin fracture treated surgically between July2013 and June 2018 were retrospectively analyzed.According to different surgical approaches,they were divided into group A(8 cases,using K-L posterior approach)and group B(7 cases,using greater trochanter osteotomy approach).There was no significant difference in gender,age,cause of injury,and interval from injury to operation between the two groups(P>0.05).The incision length,operation time,intraoperative blood loss,hospital stay,fracture healing time,and complications of the two groups were recorded.Hip joint function recovery was evaluated according to ThompsonEpstein functional evaluation system.Results All the 15 patients were followed up 1-5 years,with an average of 2.5 years.There was no significant difference in operation time between the two groups(t=14.681,P=0.100);the incision length,intraoperative blood loss,and fracture healing time in group A were all greater than those in group B,and the hospital stay was shorter than that in group B,showing significant differences(P<0.05).In group A,1 patient presented hip pain,clasthenia,and limited mobility after operation,1 patient presented ossifying myositis,1 patient presented osteonecrosis of the femoral head,1 patient presented fat liquefaction of incision,and 1 patient presented sciatica,with a complication incidence of 62.5%.Postoperative hip pain occurred in 1 patient and ossifying myositis in 2 patients in group B,with a complication incidence of 42.9%.There was no significant difference in the incidence of complications between the two groups(χ^2=-0.735,P=0.462).At last follow-up,according to Thompson-Epstein functional evaluation system,the results in group A were excellent in 3 cases,good in 2 cases,fair in 2 cases,and poor in 1 case,with an excellent and good rate of62.5%;in group B,the results were excellent in 4 cases,good in 2 cases,and fair in 1 case,and the excellent and good rate was 85.7%.There was no significant difference in good and fair rate between the two groups(χ^2=-0.990,P=0.322).Conclusion K-L posterior approach is more convenient in the fracture treatment during operation,but it has greater trauma,greater vascular damage,and more blood loss.The greater trochanter osteotomy approach can better protect the blood supply of femoral head,shorten the operation time,reduce intraoperative blood loss,and reduce postoperative complications.It is an ideal way in the surgical treatment of typeⅣPipkin fracture.