分析股骨粗隆间骨折合并同侧骨盆和(或)髋臼骨折的临床特征及治疗方案

Clinical features and therapeutic effect of femoral intertrochanteric fractures combined with ipsilateral pelvic and/or acetabular fractures

目的分析股骨粗隆间合并同侧骨盆和(或)髋臼骨折的临床特征及治疗方案。方法回顾性分析自2020-10-2022-09于河北省沧州中西医结合医院治疗的15例股骨粗隆间合并同侧骨盆和(或)髋臼骨折患者资料,记录患者性别、年龄、骨折侧别、致伤原因、股骨粗隆间骨折Evens分型、骨盆骨折Tile分型、髋臼骨折Judet-Letournel分型、合并损伤、治疗方式、受伤至手术时间、随访时间及末次随访髋关节功能Harris评分,总结此类少见且复杂骨折的临床特征、治疗方式及治疗效果。结果股骨粗隆间合并同侧骨盆和(或)髋臼骨折占同期股骨粗隆间骨折的1.19%(15/1260),其中男12例(80.00%),女3例(20.00%),年龄23~79岁,平均54.13岁。骨折侧别:左侧8例(53.33%),右侧7例(46.67%)。致伤原因:高处坠落伤10例(66.67%),平地摔伤2例(13.33%),交通事故伤2例(13.33%),重物砸伤1例(6.67%)。除2例平地摔伤患者外,其余13例均合并不同程度其他部位损伤。股骨粗隆间骨折按Evens分型:Ⅲ型2例(13.33%),Ⅳ型2例(13.33%),V型11例(73.33%)。9例合并骨盆骨折,4例合并髋臼骨折,2例同时存在骨盆环及髋臼骨折。骨盆骨折按Tile分型:A型2例(18.18%),B型2例(18.18%),C型7例(63.64%)。髋臼骨折按Judet-Letournel分型:前壁骨折3例(50.00%),前柱骨折1例(16.67%),后柱骨折1例(16.67%),后壁骨折1例(16.67%)。除2例未手术患者外,13例平均6(0~12)d后行手术治疗粗隆间及骨盆/髋臼骨折,股骨粗隆间骨折均予髓内固定,骨盆/髋臼骨折予钢板固定2例、外固定架固定3例,其余行非手术治疗。13例经13~29个月随访,平均21.50个月,髋关节功能Harris评分49~94分,平均82.00分。结论股骨粗隆间骨折合并同侧骨盆和(或)髋臼骨折的发生率低,常为高能量损伤导致的复杂骨折,且以男性居多,此类骨折术前应综合评估患者病情,根据患者综合情况选择合适手术时机、切口与内固定物,术后短期效果较好。

Objective To analyze the clinical features and treatment effect of femoral intertrochanteric fractures combined with ipsilateral pelvic and/or acetabular fractures.Methods The data of 15 patients with intertrochanteric fractures of femur combined with ipsilateral pelvic and/or acetabular fractures treated in Cangzhou Hospital of Integrated TCM-WM·Hebei from October 2020 to September 2022 were retrospectively analyzed.Gender,age,fracture sides,causes of injury,Evens classification of femoral intertrochanteric fracture,Tile classification of pelvic fracture,Judet-Letournel classification of acetabular fracture,combined injuries,treatment methods,time from injury to surgery,follow-up time and Harris scores of the injured hip at the last follow-up were recorded to summarize the clinical features,treatment methods and therapeutic effects of this rare and complex fracture.Results Femoral intertrochanteric fractures with ipsilateral pelvic and/or acetabular fractures accounted for 1.19%(15/1260)of intertrochanteric femoral fractures in the same period,including 12 males(80.00%)and 3 females(20.00%),aged 23-79 years,with an average age of 54.13 years.Fracture side:8 cases(53.33%)on the left side and 7 cases(46.67%)on the right side.The causes of injury were:10 cases(66.67%)of falling from height,2 cases(13.33%)of falling from flat ground,2 cases(13.33%)of traffic accidents,1 case(6.67%)of injury from heavy objects.Except for 2 cases of flat fall injury,the other 13 cases all combined with some kinds of other injuries.According to Evens classification,there were 2 cases of type II(13.33%),2 cases of type IV(13.33%)and 11 cases of type V(73.33%).There were 9 cases of pelvic fractures,4 cases of acetabular fractures,and 2 cases of both pelvic and acetabular fractures.Pelvic fractures were classified according to Tile classification:type A(2 cases)(18.18%),type B(2 cases)(18.18%),type C(7 cases)(63.64%).According to Judet-Letournel classification,there were 3 anterior wall fractures(50.00%),1 anterior column fracture(16.67%),1 posterior column fracture(16.67%),and 1 posterior wall fracture(16.67%).After excluding two patients without operation,13 patients received surgeries for intertrochanteric or pelvic/acetabular fractures after an average waiting time of 6 days(0-12 days).Intertrochanteric fractures of femur were all treated with intramedullary fixation,and pelvic/acetabular fractures were fixed with plate in 2 cases and external fixation in 3 cases.The rest were treated conservatively.Thirteen patients were followed up for 13 to 29 months(mean 21.50 months).The Harris score was 49 to 94(mean 82.00).Conclusion The incidence of intertrochanteric fracture of femur combined with ipsilateral pelvic and/or acetabular fracture is low.This kind of fracture is often a complex fracture caused by high-energy injury,and most of the patients are male.It should be comprehensively evaluated before surgery,and the appropriate surgical timing,incision and fixation methods should be selected according to the overall condition of the patients.The short-term postoperative effect is good.