• 蘇州大學(xué)附屬第一醫(yī)院骨科(江蘇蘇州,215006);

目的 探討影響Pipkin 骨折術(shù)后髖關(guān)節(jié)功能恢復(fù)的因素。 方法 回顧分析2002 年5 月- 2009 年2 月收治的37 例Pipkin 骨折患者臨床資料。男32 例,女5 例;年齡26 ~ 98 歲,中位年齡43 歲。致傷原因:交通事故傷31 例,摔傷4 例,高處墜落傷2 例。受傷至手術(shù)時(shí)間1 ~ 28 d,平均8.6 d。骨折根據(jù)Pipkin 分型標(biāo)準(zhǔn):Ⅱ型23 例,Ⅲ型8 例,Ⅳ型6 例。27 例采用切開復(fù)位內(nèi)固定(open reduction and internal fixation,ORIF),10 例行人工全髖關(guān)節(jié)置換(total hip arthroplasty,THA)。對(duì)性別、年齡、受傷至手術(shù)時(shí)間、骨折類型、治療方式與術(shù)后髖關(guān)節(jié)功能恢復(fù)相關(guān)關(guān)系進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果 術(shù)后患者切口均Ⅰ期愈合,無感染及下肢深靜脈血栓形成發(fā)生?;颊呔@隨訪,隨訪時(shí)間10 ~ 94 個(gè)月,平均40.5 個(gè)月。X 線片復(fù)查ORIF 患者骨折于術(shù)后5 ~ 11 個(gè)月達(dá)骨性愈合,平均8.9 個(gè)月;THA 患者無假體松動(dòng)、下沉。末次隨訪時(shí)牛津髖關(guān)節(jié)評(píng)分標(biāo)準(zhǔn)(OHS)評(píng)分為16 ~ 58 分,平均37.2 分;獲優(yōu)12 例,良13 例,可2 例,差10 例。單因素分析表明,骨折類型及治療方式對(duì)術(shù)后髖關(guān)節(jié)功能恢復(fù)有顯著影響,差異有統(tǒng)計(jì)學(xué)意義(P  lt; 0.05)。多因素分析表明,骨折類型及治療方式對(duì)術(shù)后髖關(guān)節(jié)功能恢復(fù)影響無統(tǒng)計(jì)學(xué)意義(P  gt; 0.05)。 結(jié)論 Pipkin 骨折分型及治療方式可能影響Pipkin 骨折術(shù)后髖關(guān)節(jié)功能恢復(fù),術(shù)前應(yīng)根據(jù)骨折分型選擇恰當(dāng)治療方式以保證關(guān)節(jié)功能恢復(fù)。

引用本文: 胡海,楊惠林,王根林,干旻峰,李繼剛,操志海,汪強(qiáng). Pipkin 骨折術(shù)后髖關(guān)節(jié)功能恢復(fù)影響因素分析. 中國修復(fù)重建外科雜志, 2012, 26(4): 433-436. doi: 復(fù)制

1. Kloen P, Siebenrock KA, Raaymakers EL, et al. Femoral head fractures revisited. Eur J Trauma, 2002, 28(4): 221-233.
2. 陳志文, 翟文亮, 丁真奇, 等. 一期人工全髖關(guān)節(jié)置換治療中老年P(guān)ipkin Ⅳ型股骨頭骨折. 臨床骨科雜志, 2011, 14(4): 389-391.
3. 余霄, 俞光榮, 陳雁西, 等. Pipkin骨折治療方法探討. 國際骨科學(xué)雜志, 2010, 31(4): 248-250.
4. 賈正平, 郝彥明, 王洪震, 等. Herbert螺釘前后兩路固定治療股骨頭骨折7例. 交通醫(yī)學(xué), 2011, 25(1): 47-48, 51.
5. Min BW, Kim SJ. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture. Orthopedics, 2011, 34(5): 349.
6. Pipkin G. Treatment of grade Ⅳ fracture-dislocation of the hip. J Bone Joint Surg (Am), 1957, 39-A(5): 1027-1042.
7. 干旻峰, 楊惠林, 戴思雨, 等. Herbert螺釘治療Pipkin’s骨折. 實(shí)用骨科雜志, 2007, 13(12): 715-717.
8. 李繼剛, 楊惠林, 徐耀增, 等. 選擇性一期全髖置換術(shù)治療Pipkin骨折7例分析. 中國矯形外科雜志, 2011, 19(2): 153-155.
9. Dawson J, Fitzpatrick R, Carr A, et al. Questionnaire on the perception of patients about total hip replacement. J Bone Joint Surg (Br), 1996, 78(2): 185-190.
10. Sahin V, Karaka ES, Aksu S, et al. Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. Trauma, 2003, 54(3): 520-529.
11. Miyanishi K, Yamaoto T, Isisa T, et al. Increased level of apolipoprote in B/apolipoprote in A1 ratio as a potential risk for osteonerosis. Ann Rheum Dis, 1999, 58(8): 514-516.
12. Boraiah S, Ragsdale M, Achor T, et al. Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma, 2009, 23(4): 243-248.
13. McMurtry IA, Quaie A. Closed reduction of the traumatically dislocation hip: a new technique. Injury, 2001, 32(2): 162-164.
14. Marchetti ME, Steinberg GG, Coumas JM. Intermediate-term experience of Pipkin fracture-dislocations of the hip. J Orthop Trauma, 1996, 10(7): 455-461.
15. Lederer S, Tauber M, Karpik S, et al. Fractures of femoral head. A multicenter study. Unfallehimrg, 2007, 110(6): 513-520.
16. 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.
17. Krempaský O, Knybel T. The Pipkin fracture. Acta Chir Orthop Traumatol Cech, 2001, 68(5): 304-310.
18. 張海波, 王義生, 張世清. 人工髖關(guān)節(jié)置換術(shù)在治療PipkinⅢ型骨折中的臨床應(yīng)用. 中國骨與關(guān)節(jié)損傷雜志, 2010, 25(4): 317-318.
19. 韓慶輝, 李立鈞, 陳國庭, 等. 影響髖骨節(jié)后脫位合并股骨頭骨折預(yù)后的因素分析. 中華醫(yī)學(xué)會(huì)第十三屆骨科學(xué)術(shù)會(huì)議暨第六屆COA國際學(xué)術(shù)大會(huì), 2011.
  1. 1. Kloen P, Siebenrock KA, Raaymakers EL, et al. Femoral head fractures revisited. Eur J Trauma, 2002, 28(4): 221-233.
  2. 2. 陳志文, 翟文亮, 丁真奇, 等. 一期人工全髖關(guān)節(jié)置換治療中老年P(guān)ipkin Ⅳ型股骨頭骨折. 臨床骨科雜志, 2011, 14(4): 389-391.
  3. 3. 余霄, 俞光榮, 陳雁西, 等. Pipkin骨折治療方法探討. 國際骨科學(xué)雜志, 2010, 31(4): 248-250.
  4. 4. 賈正平, 郝彥明, 王洪震, 等. Herbert螺釘前后兩路固定治療股骨頭骨折7例. 交通醫(yī)學(xué), 2011, 25(1): 47-48, 51.
  5. 5. Min BW, Kim SJ. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture. Orthopedics, 2011, 34(5): 349.
  6. 6. Pipkin G. Treatment of grade Ⅳ fracture-dislocation of the hip. J Bone Joint Surg (Am), 1957, 39-A(5): 1027-1042.
  7. 7. 干旻峰, 楊惠林, 戴思雨, 等. Herbert螺釘治療Pipkin’s骨折. 實(shí)用骨科雜志, 2007, 13(12): 715-717.
  8. 8. 李繼剛, 楊惠林, 徐耀增, 等. 選擇性一期全髖置換術(shù)治療Pipkin骨折7例分析. 中國矯形外科雜志, 2011, 19(2): 153-155.
  9. 9. Dawson J, Fitzpatrick R, Carr A, et al. Questionnaire on the perception of patients about total hip replacement. J Bone Joint Surg (Br), 1996, 78(2): 185-190.
  10. 10. Sahin V, Karaka ES, Aksu S, et al. Traumatic dislocation and fracture-dislocation of the hip: a long-term follow-up study. Trauma, 2003, 54(3): 520-529.
  11. 11. Miyanishi K, Yamaoto T, Isisa T, et al. Increased level of apolipoprote in B/apolipoprote in A1 ratio as a potential risk for osteonerosis. Ann Rheum Dis, 1999, 58(8): 514-516.
  12. 12. Boraiah S, Ragsdale M, Achor T, et al. Open reduction internal fixation and primary total hip arthroplasty of selected acetabular fractures. J Orthop Trauma, 2009, 23(4): 243-248.
  13. 13. McMurtry IA, Quaie A. Closed reduction of the traumatically dislocation hip: a new technique. Injury, 2001, 32(2): 162-164.
  14. 14. Marchetti ME, Steinberg GG, Coumas JM. Intermediate-term experience of Pipkin fracture-dislocations of the hip. J Orthop Trauma, 1996, 10(7): 455-461.
  15. 15. Lederer S, Tauber M, Karpik S, et al. Fractures of femoral head. A multicenter study. Unfallehimrg, 2007, 110(6): 513-520.
  16. 16. 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.
  17. 17. Krempaský O, Knybel T. The Pipkin fracture. Acta Chir Orthop Traumatol Cech, 2001, 68(5): 304-310.
  18. 18. 張海波, 王義生, 張世清. 人工髖關(guān)節(jié)置換術(shù)在治療PipkinⅢ型骨折中的臨床應(yīng)用. 中國骨與關(guān)節(jié)損傷雜志, 2010, 25(4): 317-318.
  19. 19. 韓慶輝, 李立鈞, 陳國庭, 等. 影響髖骨節(jié)后脫位合并股骨頭骨折預(yù)后的因素分析. 中華醫(yī)學(xué)會(huì)第十三屆骨科學(xué)術(shù)會(huì)議暨第六屆COA國際學(xué)術(shù)大會(huì), 2011.