大转子截骨术治疗PipkinⅠ和Ⅱ型股骨头骨折疗效观察

摘要

目的评估大转子截骨术治疗PipkinⅠ和Ⅱ型股骨头骨折的中远期临床疗效。方法回顾分析采用大转子截骨术治疗股骨头骨折并髋关节后脱位患者23例，其中男性15例，女性8例，平均年龄44.1岁。临床疗效依据和d'Aubigne-Postel评分标准而确定。结果除1例患者因随访少于12个月而没有纳入研究外，余22例患者随访时间均不少于12个月。患者平均随访时间为23.5个月（最短12个月，最长36个月）。最后一次随访d'Aubigne-Postel的评分为13.41±4.0分；Thompson-Epstein的临床评价结果：8例优（36.4%），9例良（40.9%），3例一般（13.6%），2例差（9.1%），优良率为77.3%。患者术后无脱位发生，2例患者术后发生异位骨化，1例坐骨神经损伤患者术后6月后完全恢复正常，3例患者出现术后创伤性关节炎，其中1例术后1年因发生股骨头缺血坏死而行髋关节置换术。结论随访结果表明对于PipkinⅠ和Ⅱ型股骨头骨折，大转子截骨术是可行且有效的手术方法。%Objective To investigate the mid- and long-term clinical results of trochanteric flip osteotomy for treating Pipkin type I and II femoral head fractures. Methods We retrospectively reviewed twenty-three patients (aged 23-72 years with a mean of 44.1 years, including 15 male and 8 female patients) with femoral head fractures and posterior hip dislocation. The fracture was classified according to Pipkin classification based radiographic findings, and 9 patients were found to have type I and 14 had type II fractures. Trochanteric flip osteotomy was performed in all patients for surgical open reduction and internal fixation of the fractures. The clinical and radiographic outcomes of the patients were measured using Thompson-Epstein scoring scale and Merle d' Aubigne-Postel score. Results One patient with follow-up period less than 12 months was excluded from analysis. Of the 22 patients (95.7%) followed up for more than 12 months (mean 23.5 months), the average Merle d' Aubigne Postel score was 13.77 at the final follow-up. According to the Thompson-Epstein criteria, 8 (36.4%) patients had excellent, 9 (40.9%) had good, 3 (13.6%) had fair, and two (9.1%) had poor outcomes; the total rate of excellent and good outcomes was 77.3% in these 22 patients. None of the patients developed habitual dislocation of the femoral head after the operation. Heterotopic ossification occurred in 2 patients. Partial neurapraxia of the sciatic nerve occurred in one patient and recovered completely within 6 months. Three patients developed post-traumatic arthritis, and one of them had avascular necrosis of the femoral head one year after surgery and received subsequently total hip arthroplasty. Conclusion The follow-up data demonstrate that trochanteric flip osteotomy is an effective and reliable option for treating Pipkin type I and type II femoral head fractures.