Posterior hip dislocation combined with femoral head fractures: effects of typing and repair methods

doi:10.3969/j.issn.2095-4344.2014.13.002

Abstract

Abstract:

BACKGROUND: Posterior hip dislocation combined with femoral head fractures easily induced femoral head necrosis, ectopic ossification, osteoarthritis and deep vein thrombosis. Different therapeutic methods should be utilized according to the type of fracture.
OBJECTIVE: To investigate the factors affecting the therapeutic effects and complications following surgery of posterior hip dislocation combined with femoral head fractures.
METHODS: Twenty-eight patients, who had been diagnosed as posterior hip dislocation combined with femoral head fractures in the 101 Hospital of Chinese PLA from September 2004 to May 2010, were enrolled in this study. According to Pipkin typing, operative approach and the time from injury to surgery, therapeutic effects were evaluated using radiographs and the recovery conditions of hip function (Epstein method), and the occurrence of complications was recorded.
RESULTS AND CONCLUSION: A total of 28 patients were followed up from 1 to 5 years, averagely 2.8 years. Using the Epstein method, there were excellent in 6 cases, good in 12 cases, average in 7 cases, and poor in
3 cases, with an excellent and good rate of 64%. The therapeutic effects in patients with Pipkin I and II were good, with excellent and good rates of 100% and 78%, respectively. Moreover, the complications were less, with a rate of 17% and 22%, respectively. The therapeutic effects of patients with Pipkin III and IV were poor, especially, Pipkin IV patients, whose excellent and good rate was only 20% and the incidence of complications was 80%. No significant difference in the incidence of complications was detected in patients undergoing Smith-Peterson anterior approach and K-L posterior approach (P > 0.05). No significant difference in the incidence of complications was detectable among patients from three groups (the time from fracture to operation < 12 hours, 12-48 hours, and > 48 hours) (P > 0.05). Results indicated that the choice of treatment method should be
determined by the type of fracture. The prognosis depends on the patient’s age, time of treatment, types of fracture and dislocation, methods of treatment and related measures of prevention of complications.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: femoral fractures, femur head, hip dislocation, treatment outcome, postoperative complications

CLC Number:

R318

Tan Zhang-yong, Wang Jian-liang, Guo Feng, Liu Wei-feng, Xu Ke-feng. Posterior hip dislocation combined with femoral head fractures: effects of typing and repair methods[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(13): 1975-1980.

Figures/Tables 3

References

[1] 卢世壁,王岩.坎贝尔骨科手术学[M].10版.山东科学技术出版社, 2003:2810-2811.

[2] 胥少汀,葛宝丰,徐印坎. 实用骨科学[M].3版.北京:人民军医出版社,2008:708.

[3] Schmidt GL, Sciulli R, Altman GT.Knee injury in patients experiencing a high-energy traumatic ipsilateral hip dislocation.J Bone Joint Surg Am. 2005;87(6):1200-1204.

[4] Brumback RJ, Kenzora JE, Levitt LE,et al.Fractures of the femoral head.Hip. 1987:181-206.

[5] Zehi K, Karray S, Litaiem T,et al.Fracture-luxation of the femur head. Apropos of 10 cases.Acta Orthop Belg. 1997;63(4): 268-273.

[6] Thompson VP ,Epstein HC.Traumatic dislocation of the hip; a survey of two hundred and four cases covering a period of twenty-one years.J Bone Joint Surg Am. 1951;33-A(3): 746-478.

[7] Stewart MJ, Miflord LW.Fracture-dislocation of the hip; an end-result study.J Bone Joint Surg Am. 1954;36(A:2):315- 342.

[8] Pipkin G.Treatment of grade IV fracture-dislocation of the hip.J Bone Joint Surg Am. 1957;39-A(5):1027-1042.

[9] Hougaard K, Thomsen PB.Traumatic posterior fracture-dislocation of the hip with fracture of the femoral head or neck, or both.J Bone Joint Surg Am. 1988;70(2):233-239.

[10] Tripathy SK, Sen RK, Goyal T.Conservative versus surgical management of Pipkin type I fractures associated with posterior dislocation of the hip: a randomised controlled trial.Int Orthop. 2011;35(12):1907-1908

[11] Thannheimer A, Gutsfeld P, Bühren V.Current therapy options for fractures of the femoral head.Chirurg. 2009;80(12):1140- 1146.

[12] Stannard JP, Harris HW, Volgas DA,et al.Functional outcome of patients with femoral head fractures associated with hip dislocations.Clin Orthop Relat Res. 2000;(377):44-56.

[13] 张涛,马宝通,庞贵根,等. Pipkin骨折分型的临床研究[J].中华创伤杂志,2011,27(7):608-613.

[14] 蔡贤华,陈庄洪,徐永年,等.不同髋臼骨折手术入路选择的相关性因素分析[J] .中国矫形外科杂志, 2006, 14(20): 1526-1528.

[15] 高曙光,雷光华,李康华,等. 后侧入路可吸收螺钉内固定治疗股骨头骨折[J] .医学临床研究,2007,24(2):322-324.

[16] 梁笃,杨冰,郑永华,等. Kocher-Langenbeck入路治疗髋臼后壁骨折合并股骨头骨折[J].中医正骨,2013,25(6):38-39,41.

[17] Jessberger S, Blattert TR, Wagner R,et al.Reducing approach-associated morbidity in fracture dislocation of the femoral head--a longitudinal study (1982-2000).Zentralbl Chir. 2002;127(6):485-489.

[18] Tannast M, Siebenrock KA.Operative treatment of T-type fractures of the acetabulum via surgical hip dislocation or Stoppa approach.Oper Orthop Traumatol. 2009;21(3): 251-269.

[19] 郭涛,肖冬生,董华. 髋关节后脱位并股骨头骨折治疗体会[J].当代医学,2009,15(18):95-96.

[20] 倪宏伟,李正维,周伟,等.采用前路切口治疗Pipkin Ⅰ、Ⅱ型股骨头骨折[J].中国矫形外科杂志 ,2007,15(10):786-787.

[21] 高苏宁,赵红军,苏明海,等.股骨头骨折的手术治疗探讨[J].实用骨科杂志,2006,12(2):116-117.

[22] Lang-Stevenson A, Getty CJ.The Pipkin fracture-dislocation of the hip.Injury. 1987;18(4):264-269.

[23] Mat?jka J, Koudela K.Bilateral fractures of the femoral head (Pipkin I and Pipkin II).Acta Chir Orthop Traumatol Cech. 2002;69(6):369-371.

[24] Tonetti J, Ruatti S, Lafontan V, et al.Is femoral head fracture-dislocation management improvable: A retrospective study in 110 cases.Orthop Traumatol Surg Res. 2010; 96(6): 623-631.

[25] Gö?ü? A, Akpinar S, Unal M, et al.Hip fracture-dislocation (Pipkin type IV) associated with an apparent traumatic aortic valve rupture. Case history.Ulus Travma Derg. 2001;7(1): 66-69.

[26] 甄平,李旭升,田琦,等.一期全髋关节置换术治疗Pipkin Ⅳ型骨折合并股骨转子间骨折[J].中华创伤骨科杂志,2012,14(8):689- 692.

[27] 刘伟乐,易瑜华,孙春汉. Pipkin骨折手术治疗体会[J].河南外科学杂志,2013,19(3):86.

[28] 李淳德,马忠泰,吴常德,等.可吸收螺钉及固定棒(SR-PGA,PLLA)临床应用的初步报告[J].中华骨科杂志,2009,15(11):755-757.

[29] 黄相杰,周志高,姜红江等.国产可吸收钉在治疗髋部骨折中的应用[J].骨与关节损伤杂志,2004,19(2):93.

[30] 姜保国,张殿英,付中国.股骨近端骨折的治疗[J].中华创伤骨科杂志,2004,6(5):484-487.

[31] Marchetti ME, Steinberg GG, Coumas JM.Intermediate-term experience of Pipkin fracture-dislocations of the hip.J Orthop Trauma. 1996;10(7):455-461.

[32] Henle P, Kloen P, Siebenrock KA.Femoral head injuries: Which treatment strategy can be recommended?Injury. 2007; 38(4):478-488.

[33] 陈志文,丁真奇,林斌,等.骨块切除术治疗PipkinⅠ型股骨头骨折[J].实用骨科杂志,2011,17(10):928-930.

[34] 王仁,齐东海,许向东,等.切开复位可吸收螺钉和重建钢板内固定治疗Pipkin Ⅳ型骨折[J].中华创伤骨科杂志,2013,15(8):722- 723.

[35] 刘欣伟,苏佳灿,张春才. Pipkin骨折临床治疗18例分析[J].创伤外科杂志,2008,10(3):241-243