CAJ | 학술논문

目的探讨髋臼合并同侧股骨颈骨折的手术方法与预后.方法 1990年10月至2008年1月共收治7例髋臼合并同侧股骨颈骨折患者,其中男5例,女2例;年龄22～55岁(平均38.6岁).髋臼骨折按Letournel分类:后壁骨折2例,后柱伴后壁骨折1例,横行伴后壁骨折2例,双柱骨折2例.股骨颈骨折按Garden分型:Ⅲ型2例,Ⅳ型5例.其中X线片和CT片示股骨颈骨折合并股骨头游离脱位于髋臼后上方者5例,仅显示股骨颈骨折而无脱位者2例.结果切开复位内固定术后X线片示5例移位髋臼骨折患者获解剖复位,2例获满意复位.股骨颈骨折均获满意复位和固定.7例患者术后获1～18年(平均8.6年)随访,X线片示5例合并股骨头脱位者日后均出现股骨头缺血性坏死,坏死率高达100%(5/5),髋关节功能恢复均为差,于内固定术后2～4年改行全髋关节置换术.而2例股骨头未脱位者至今X线片上仍未显示任何股骨头坏死迹象,也无创伤后关节炎表现,髋关节功能恢复均为优.结论髋臼合并同侧股骨颈骨折患者,如同时合并股骨头脱位,因股骨头坏死率高,应首选全髋关节置换术治疗.如未合并股骨头脱位,可以考虑首选切开复位内固定.
목적 탐토관구합병동측고골경골절적수술방법여예후.방법 1990년10월지2008년1월공수치7례관구합병동측고골경골절환자,기중남5례,녀2례;년령22～55세(평균38.6세).관구골절안Letournel분류:후벽골절2례,후주반후벽골절1례,횡행반후벽골절2례,쌍주골절2례.고골경골절안Garden분형:Ⅲ형2례,Ⅳ형5례.기중X선편화CT편시고골경골절합병고골두유리탈위우관구후상방자5례,부현시고골경골절이무탈위자2례.결과절개복위내고정술후X선편시5례이위관구골절환자획해부복위,2례획만의복위.고골경골절균획만의복위화고정.7례환자술후획1～18년(평균8.6년)수방,X선편시5례합병고골두탈위자일후균출현고골두결혈성배사,배사솔고체100%(5/5),관관절공능회복균위차,우내고정술후2～4년개행전관관절치환술.이2례고골두미탈위자지금X선편상잉미현시임하고골두배사적상,야무창상후관절염표현,관관절공능회복균위우.결론 관구합병동측고골경골절환자,여동시합병고골두탈위,인고골두배사솔고,응수선전관관절치환술치료.여미합병고골두탈위,가이고필수선절개복위내고정.
Objective To discuss the efficacy of open reduction and internal fixation in the treatment of acetabular fractures associated with ipsilateral femoral neck fracture.Methods From October 1990 to January 2008,5 male and 2 female cases of acetabular fractures associated with ipsilateral femoral neck fractures were treated with open reduction and internal fixation.Their mean age was 38 years.According to the Letournel classification,fractures involved posterior acetabular wall in 2 cases,posterior column plus posterior wall in 1,transverse acetabulum plus posterior wall in 2 and both columns in 2.According to the Garden classification,2 patients had type Ⅲ fracture and 5 type Ⅳ.Both X-ray films and CT scans showed 5 cases were associated with femoral head dislocation.Results All the 7 patients were followed up for 1 to 18 years (average,9 years).Postoperative X-ray films showed anatomic reduction of acetabular fracture in 5 cases and satisfactory reduction in 2 cases,as well as satisfactory reduction of femoral neck fracture in all the patients.Postoperative X-ray films also revealed necrosis of femoral head in the 5 patients who had femoral neck fractures and femoral head dislocation,but not in the other 2 who had no femoral head dislocation.Conclusions Total hip replacement should be the treatment of choice for patients who are complicated with femoral neck fracture and femoral head dislocation,because the rate of necrosis of femoral head is very high.For patients who have no femoral head dislocation,however,open reduction and internal fixation is the best choice for primary treatment.