This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fractu...This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.展开更多
文摘髋关节不稳(hip instability)是一种因股骨头无法与髋臼保持稳定匹配,导致髋关节不稳定/半脱位和疼痛的功能异常性疾病。临床上常常被漏诊,还可导致患者髋关节过度磨损退化和骨关节炎等多种并发症。目前关于髋关节不稳仍缺乏充分的认识和标准化的诊疗方案。通过检索PubMed、Web of Science、Cochrane library、中国知网、万方全文数据库、维普科技期刊数据库,根据纳入及排除标准进行筛选,纳入文献85篇。总结归纳文献发现,导致髋关节不稳的病理机制包括髋臼覆盖不足、髋臼股骨头的匹配不良、髋关节周围软组织缺损或松弛、撞击综合征等多种因素,目前认为主要包括创伤性、发育性、微不稳、医源性、结缔组织病源性和特发性髋关节不稳等6种类型。通过临床症状、体格检查和影像学检查相结合,可对髋关节不稳进行充分评估和鉴别。治疗方案主要包括控制活动量、康复锻炼等保守治疗和髋关节周围截骨、关节镜下关节囊韧带重叠缝合/重建或盂唇修复/重建等手术治疗。
文摘This paper discussed the injury mechanism and management of a patient who had concomitant ipsilateral hip and knee dislocations and contralateral open leg fracture. A 32-year-old man presented with ipsilateral fracturedislocations of the left hip （Pipkin＇s type IV） and knee （Moore II）joints and contralateral open fracture of the leg bones after a car accident. After emergency resuscitative measures, the hip joint was reduced and Pipkin＇s fracture was fixed using Ganz approach with lag screws; knee joint was reduced closely and tibial plateau fracture was stabilized with lateral buttress plate and a transarticular spanning fixator. The open fracture on the other leg was debrided and fixed with an external fixator. There was no insta-bility in both joints after fixation when he was examined under anesthesia. The fractures united after 3 months and the patient had no residual instability of hip and knee. There was no clinical or radiological evidence of osteonecrosis in the hip joint after 6 months. At one-year follow-up, he had satisfactory functional outcome with almost normal range of motion at both joints. Ipsilateral hip and knee dislocations are rare injuries and more caution is needed for early diagnosis. A timely appropriate intervention can provide good functional outcome to the patient in this situation.
