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-  2015 

髋关节外科脱位入路治疗股骨头骨折

DOI: doi:10.7507/1002-1892.20150287

Keywords: 股骨头骨折, 髋关节脱位, 手术入路

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Abstract:

目的探讨髋关节外科脱位入路在股骨头骨折治疗中的应用效果。 方法回顾分析2010年1月-2013年2月采用髋关节外科脱位入路治疗的15例股骨头骨折患者临床资料,其中男11例,女4例;年龄15~63岁,平均30.8岁。致伤原因:交通事故伤9例,高处坠落伤5例,运动伤1例。按Pipkin分型:Ⅰ型2例,Ⅱ型7例,Ⅲ型1例,Ⅳ型5例。受伤至手术时间2~10 d,平均4.1 d。除5例入院前于外院复位,余10例均在伤后6 h内复位并行骨牵引,术后持续牵引4~6周。 结果术后切口均Ⅰ期愈合,无脱位和下肢深静血栓形成等早期并发症。15例均获随访,随访时间25~36个月,平均29.9个月。无感染、内固定物断裂、股骨大转子骨折不愈合等并发症发生。随访期间3例出现股骨头坏死,其中2例无症状,MRI检查明确为国际骨循环协会(ARCO)分期Ⅱ a和Ⅱ b期;1例Ⅲ b期股骨头坏死且股骨颈骨折不愈合,行人工全髋关节置换术。4例发生骨化性肌炎,按Brooker分级为Ⅰ级2例、Ⅱ级1例、Ⅲ级1例,除1例行人工全髋关节置换术时清理,余未手术治疗。末次随访时按照Thompson-Epstein评价系统评价关节功能,获优9例,良3例,可1例,差2例,优良率80%。 结论髋关节外科脱位入路既能保护股骨头残存血管又能充分显露髋臼和股骨头,是治疗股骨头骨折的理想入路

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