| 吴勇刚,鲜成树,付锦江,等.直接前方入路联合髋关节正前方辅助小切口可吸收螺钉固定治疗Pipkin Ⅰ、Ⅱ型股骨头骨折疗效分析.骨科,2024,15(1): 36-40. |
| 直接前方入路联合髋关节正前方辅助小切口可吸收螺钉固定治疗Pipkin Ⅰ、Ⅱ型股骨头骨折疗效分析 |
| Curative Effectiveness of DAA Approach Combined with Absorbable Screw Fixation through Auxiliary Small Incision in front of the Hip Joint for the Treatment of Pipkin Type Ⅰ and Ⅱ Femoral Head Fractures |
| 投稿时间：2023-07-02 |
| DOI：10.3969/j.issn.1674-8573.2024.01.007 |
| 中文关键词: 股骨头骨折 DAA入路 髋关节正前方辅助小切口 可吸收螺钉 固定 |
| 英文关键词: Femoral head fractures DAA approach Auxiliary small incision in front of the hip joint Absorbable screw Fixation |
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| 中文摘要: |
| 目的 探讨直接前方入路（direct anterior approach，DAA）联合髋关节正前方辅助小切口可吸收螺钉固定治疗Pipkin Ⅰ、Ⅱ型股骨头骨折的临床疗效。方法 回顾性分析我院骨科2017年2月至2022年7月收治的13例Pipkin Ⅰ、Ⅱ型股骨头骨折病人的临床资料，男7例，女6例，平均年龄41.6岁（28~57岁）；Pipkin Ⅰ型8例，Pipkin Ⅱ型5例。病人经DAA入路联合髋关节正前方辅助小切口可吸收螺钉固定手术治疗。收集病人手术时间、术中出血量、并发症发生情况；通过术后X线片、CT随访了解骨折愈合时间；末次随访时采用疼痛视觉模拟量表（visual analogue scale，VAS）评分、Harris评分、Thompson-Epstein评分进行髋关节功能评价。结果 13例病人平均手术时间103.7 min（86~116 min），平均术中出血量96.3 mL（70~100 mL），平均随访时间14.6个月（12~18个月）。未发生股神经、股外侧皮神经、股血管损伤等并发症，无切口感染。末次随访时病人VAS评分、Harris评分为（0.15±0.38）分、（95.00±7.15）分，均较术前［（5.38±1.19）分、（17.00±4.78）分］明显改善，差异有统计学意义（P＜0.001）。所有病人骨折均愈合，平均愈合时间3.6个月（3~8个月）。末次随访时无股骨头坏死、异位骨化发生，1例病人发生髋关节创伤性关节炎。末次随访Thompson-Epstein评价结果，优11例、良2例。结论 DAA入路联合髋关节正前方辅助小切口可吸收螺钉固定治疗Pipkin Ⅰ、Ⅱ型股骨头骨折，软组织损伤小，骨折部位显露清楚，可吸收螺钉固定效果确切，并发症发生率低，可作为Pipkin Ⅰ、Ⅱ型股骨头骨折的手术治疗方案。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy of direct anterior approach (DAA) combined with absorbable screw fixation through auxiliary small incision in front of the hip joint for the treatment of Pipkin type Ⅰ and Ⅱ femoral head fractures. Methods The clinical data of 13 patients with Pipkin Ⅰ and Ⅱ type femoral head fractures admitted to our hospital from February 2017 to July 2022 were retrospectively analyzed. There were 7 males and 6 females, with an average age of 41.6 years (28-57 years). There were 8 cases of Pipkin type Ⅰ and 5 cases of Pipkin type Ⅱ. The patients underwent DAA approach combined with anterior hip joint assisted small incision absorbable screw fixation surgery. The operation time, intraoperative bleeding volume, and incidence of complications were recorded. The healing time of fractures was determined through postoperative X-ray and CT follow-up. At the last follow-up, hip joint function was evaluated using the visual analog scale (VAS) score, Harris score, and Thompson-Epstein score. Results The average surgical time for 13 patients was 103.7 min (86-116 min), with an average intraoperative bleeding of 96.3 mL (70-100 mL). The average follow-up time was 14.6 months (12-18 months). No complications such as femoral nerve, lateral femoral cutaneous nerve, or femoral vascular injury occurred, and there was no incision infection. At the last follow-up, the patients' VAS score and Harris score were (0.15±0.38) and (95.00±7.15) respectively, both of which showed significant improvement compared to preoperative scores ［(5.38±1.19) and (17.00±4.78)］ (P＜0.001). All patients had fractures that healed, with an average healing time of 3.6 months (3-8 months). At the last follow-up, there was no occurrence of femoral head necrosis or ectopic ossification, and one patient developed traumatic arthritis of the hip joint. The results of Thompson-Epstein evaluation at the last follow-up were excellent in 11 cases, good in 2 cases. Conclusion DAA approach combined with absorbable screw fixation through auxiliary small incision in front of the hip joint for the treatment of Pipkin type Ⅰ and Ⅱ femoral head fractures has small soft tissue damage, clear exposure of the fracture site, accurate fixation effect of absorbable screws through auxiliary small incision, and low incidence of complications. It can be used as an option for surgical treatment of Pipkin I and Pipkin II femoral head fractures. |
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