CAJ | 학술논문

目的探讨浮髋损伤的发生机制、治疗策略、手术疗效及并发症治疗.方法回顾性分析2001年6月至2011年6月收治的33例浮髋损伤患者资料,男25例,女8例；年龄4～73岁,平均34.6岁；车祸伤20例,高处坠落伤11例,重物砸伤1例,平地摔伤1例.根据Liebergall分型方法,Ⅰ型7例,Ⅱ型9例,Ⅲ型17例.患者均有合并伤,损伤严重度评分为16～55分,平均28.9分.32例股骨骨折行手术治疗,其中采用钢板或髓内钉固定29例,外固定架固定1例,行全髋关节置换2例；髋臼骨折采用重建钢板固定16例；骨盆骨折采用钢板、拉力螺钉或外固定架固定13例.结果 28例(84.8％,28/33)患者获得随访,随访时间为2.3～10.1年,平均3.5年.其中Ⅰ型和Ⅱ型共13例获得随访,根据Majeed评价标准评价髋关节功能,优8例,良3例,可2例,优良率84.6％(11/13)；Ⅲ型15例获得随访,根据D' Aubigné和Postel标准评价髋关节功能:优7例,良4例,可3例,差1例,优良率73.3％(11/15).伤侧膝关节功能按马元璋等评定标准:优23例,良3例,可1例,差1例,优良率92.9％(26/28).并发症包括:创伤性关节炎(1例),坐骨神经损伤(2例),异位骨化(2例),股骨头坏死(1例),股骨骨不连(2例).结论浮髋损伤属于复杂性损伤,常由高能量损伤引起,在抢救生命的基础上,对股骨骨折优先进行固定,而后再行髋臼及骨盆骨折治疗.创伤性关节炎、坐骨神经损伤、异位骨化、股骨头坏死、股骨骨不连是浮髋损伤较常见的并发症.
목적 탐토부관손상적발생궤제、치료책략、수술료효급병발증치료.방법 회고성분석2001년6월지2011년6월수치적33례부관손상환자자료,남25례,녀8례；년령4～73세,평균34.6세；차화상20례,고처추락상11례,중물잡상1례,평지솔상1례.근거Liebergall분형방법,Ⅰ형7례,Ⅱ형9례,Ⅲ형17례.환자균유합병상,손상엄중도평분위16～55분,평균28.9분.32례고골골절행수술치료,기중채용강판혹수내정고정29례,외고정가고정1례,행전관관절치환2례；관구골절채용중건강판고정16례；골분골절채용강판、랍력라정혹외고정가고정13례.결과 28례(84.8％,28/33)환자획득수방,수방시간위2.3～10.1년,평균3.5년.기중Ⅰ형화Ⅱ형공13례획득수방,근거Majeed평개표준평개관관절공능,우8례,량3례,가2례,우량솔84.6％(11/13)；Ⅲ형15례획득수방,근거D' Aubigné화Postel표준평개관관절공능:우7례,량4례,가3례,차1례,우량솔73.3％(11/15).상측슬관절공능안마원장등평정표준:우23례,량3례,가1례,차1례,우량솔92.9％(26/28).병발증포괄:창상성관절염(1례),좌골신경손상(2례),이위골화(2례),고골두배사(1례),고골골불련(2례).결론 부관손상속우복잡성손상,상유고능량손상인기,재창구생명적기출상,대고골골절우선진행고정,이후재행관구급골분골절치료.창상성관절염、좌골신경손상、이위골화、고골두배사、고골골불련시부관손상교상견적병발증.
Objective To discuss the mechanism of injury,treatment decisions,complications and surgical results of the floating hip injuries (FHI).Methods Thirty-three patients with FHI were retrospectively analyzed in our hospital from June 2001to June 2011.There were 25 males and 8 females,with an average age of 34.6 years (range,4-73 years).The mechanism of injury was motor vehicle collision for 20 patients,fall down from a height for 11,crushed injury for 1,and sports-related injury for 1.According to Liebergall classification for the floating hip injuries,there were 7 cases for type Ⅰ (21.2％),9 for type Ⅱ (27.2％)and 17 for type Ⅲ (51.6％).All patients had associated injuries,the average injury severity score (ISS) was 28.9.Thirty-two of the femoral fractures underwent surgical stabilization of their femoral fractures.Surgical stabilization methods included ORIF or intramedullary nailing (29 cases),external fixation (1 case),total hip arthroplasty (2 cases).Acetabular fractures were treated with open reduction and internal fixation (ORIF) in 16 cases.Thirteen patients suffered pelvic fractures underwent surgical stabilization for at least one component of ring disruption.Results Twenty-eight cases (84.8％) were followed up for 2.3 to 10.1 years (average,3.5 years).Thirteen patients were followed up in the 16 patients who suffered type Ⅰ or Ⅱ fractures.According to Majeed functional evaluation,the results were excellent in 8 cases,good in 3 and fair in 2,with the excellent and good rate being 84.6％.Fifteen patients with type Ⅲ were followed up,according to D'Aubigné and Postel evaluation criterion.The joint functions were excellent in 7 cases,good in 4,fair in 3,and poor in 1,with the excellent and good rate being 73.3％.According to Ma Yuanzhang functional evaluation,the knee functions of the all patients were excellent in 23 cases,good in 3,and fair in 2,with the excellent and good rate being 92.9％.Complications seen in these patients included post-traumatic osteoarthritis of the hip developed in one hips,2 patients developed heterotopic ossification (HO),one case of avascular necrosis of the femoral head,and two femoral nonunions.The most severe complication was traumatic sciatic nerve palsy,which was found in 5 patients.Conclusion Ipsilateral injuries to the femur and the pelvis or acetabulum (floating hip) are severe injuries usually caused by high-energy trauma.The femur fracture will most commonly be addressed first,and surgeons should be aware of the high incidence of sciatic nerve palsy as well as treatment options and potential complications associated with this devastating combination of injuries.