改良Smith-Peterson入路辅助经皮中空钉治疗Pipkin Ⅰ型骨折的疗效观察

Observation on the curative effect of application of modified Smith-Peterson(S-P) approach assist percutaneous cannulated screws treatment Pipkin Ⅰ type fractures

目的探讨应用改良Smith-Peterson(S-P)入路辅助经皮中空钉治疗PipkinⅠ型骨折的临床疗效。方法 2014年5月~2019年9月我院收治的PipkinⅠ型骨折病人10例,应用改良S-P入路辅助经皮中空钉治疗,记录手术时间、术中出血、住院时间以及相关并发症发生情况,定期复查X线及骨三维CT了解骨折愈合情况,髋关节Harris评分和Thompson-Epstein评分法评估疗效。结果手术时间70~130分钟,平均(90.5±4.6)分钟,术中出血量90~210ml,平均(125.6±12.4)ml,住院时间15~33天,平均(23.6±3.7)天;术中复位及固定顺利,骨折均达到解剖复位。10例病人术后均获随访,随访时间12~36个月,平均(23±2.1)个月,无并发症发生,骨折均骨性愈合;术后12个月髋关节Harris评分为(85.6±4.3)分,较术前(27.3±3.4)分有明显改善,差异有统计学意义(P<0.05)。末次随访时Thompson-Epstein临床评价标准:优7例、良2例、可1例,优良率90.0%。结论应用改良S-P入路辅助经皮中空钉治疗PipkinⅠ型骨折,可充分暴露及垂直骨折线牢固固定股骨头骨折,显露效果好、创伤小、出血量少、手术时间短,有助于术后髋关节功能早期恢复。

Objective Discusses the curative effect of application of modified Smith-Peterson(S-P) approach assist percutaneous cannulated screws treatment Pipkin Ⅰ type fractures.Methods The clinical data(Duration of surgery, intraoperative bleeding, and length of hospital stay)from 10 cases of application of modified Smith-Peterson(S-P) approach assist percutaneous cannulated screws treatment Pipkin Ⅰ type fractures from May 2014-September 2019 were analyzed retrospectively, and the incidence of related complications was recorded, periodically review X-ray and bone 3-D CT to understand fracture healing, Follow-up records of the hip joint Harris score and Thompson-Epstein score to evaluate the efficacy.Results The operation time was 70-130 min[(90.5±4.6) min],the intraoperative blood loss was 90-210 ml[(125.6±12.4) ml],and the hospitalization period was 15-33 d[(23.6±3.7) d].Intraoperative reduction and fixation were smooth, and all fractures reached anatomical reduction;All 10 patients were followed up after the operation.The follow-up time was 12~36 months[(23±2.1) months].No complications occurred, and all fractures were bony healing.The Harris score of hip joint 12 months after operation was(85.6±4.3),which was significantly improved compared with that before operation(27.3±3.4),and the difference was statistically significant(t=9.52,P<0.05).Thompson-Epstein clinical evaluation criteria at the last follow-up: 7 cases were excellent, 2 cases were good, 1 case was fair, and the excellent and good rate was 90.0%.Conclusion Application of modified Smith-Peterson(S-P) approach auxiliary percutaneous cannulated screws treatment Pipkin Ⅰ type fractures can fully expose and firmly fix the femoral head fracture with the vertical fracture line.It has good exposure effect, less trauma, less bleeding, short operation time, and helps early recovery of hip function after surgery.It is worthy of clinical application.