Surgical Dislocation Of Hip Joint For The Treatment Of Pipkin Fracture Combined With Acetabular Labial Injury

Objectives:1:To explore the clinical feasibility of dislocation treatment of hip surgery in the treatment of Pipkin fracture with acetabular labrum injury.2:To investigate the th-erapeutic effect and the incidence of clinical complications after operation.3:To study the incidence and treatment of acetabular labrum injury in Pipkin fracture.Methods:Collect 15 Pipkin patients admitted to the Central Hospital Affiliated to Shenyang Medical College from 2016 to 2018 and evaluate the HHS scores.After admission,the patients are treated with bone traction after manual reduction of hip dislocation,and further underwent imaging examination to determine the fracture displacement,injury type and whether combined with acetabular labrum injury,so as to impro-ve preoperative preparation.Use the 3-D printing technique to assist the treatment of type Ⅲ and Ⅳ fractures,all patients are treated by the same surgeon through the su-rgical dislocation approach of hip joint after the contraindications are excluded.Ex-plore the acetabular labrum during operation and suture it with anchor if there is injury.After operation,patients are given routine analgesia,low molecular weight heparin,indomethacin,lower limb barometric pump and other treatments,and instru cted by the same doctor to perform functional rehabilitation exercises.Conduct pos-toperative follow-up,and record the complications of acetabular labrum injury,the postoperative HHS score,the Thompson and Epstein clinical and imaging evaluation criteria,as well as the complications such as deep vein thrombosis,avascular necrosis of femoral head(ANFH),heterotopic ossification and nonunion of fracture.Results:15 patients with unilateral hip dislocation and fracture are collected,including 9 males and 6 females;8 left and 7 right;aged 20-65 years(average 40.6 years).The HHS score of admission is 2-12 points(average 5.9 points).Pipkin fracture classification based on imaging data:6 cases of type Ⅰ,4 cases of type Ⅱ,1 case of type Ⅲ and 4 cases of type Ⅳ;MRI examination suggest that 10 patients with acetabular labrum injury.The reset time of hip dislocation after injury is 2-12 hours(average 5.57 hours),and the operation time is 24-72 hours(average 29.8 hours).All patients were operated by Professor Park Chengzhe through the surgical dislocation approach of hip joint.During the operation,the femoral head and acetabulum are fully exposed,and the injury of hip joint is explored in all directions;during the reduction of femoral head,fresh blood seep evenly from the pinhole when the guide needle is inserted,the redu-ced bone is fixed with headless compression cannulated screw,the injured acetabular labrum is repaired with suture anchor and the greater trochanter osteotomy block is fixed with ordinary cortical screw.Intraoperative exploration shows that all the pat-ients(15 cases)are accompanied by varying degrees of acetabular labrum tear,which is repaired by anchor fixation with sutures.Postoperative follow-up shows that all patients with femoral head fracture and greater trochanter osteotomy healed well,with healing time of(3.42±0.54 M);follow-up for 1 year:HHS score 85-95(average 90.3),excellent group:11/15,better group:4/15.Thompson and Epstein clinical and ima-ging evaluation:excellent:11 cases,good:3 cases,fair:1 case.One patient with type IV fracture is found to have femoral head necrosis on X-ray at the latest follow-up(10 months after operation),two patients presented with heterotopic ossification(2/1 5),the remaining patients have no complications such as deep venous thrombosis of lower limbs,significant avascular necrosis of femoral head(ANFH)and fracture nonunion during the 1 year follow-up.Conclusions:1.The incidence of acetabular labrum injury in Pipkin fracture is higher(15\15),whi-ch can not be ignored clinically;and the clinical effect of anchored suture repair is sat-isfactory.2.The treatment of Pipkin fracture by surgical dislocation approach of hip joint is feasible and fully exposed.The rate of femoral head necrosis after operation is low(115)and the curative effect is satisfactory.3.Complex fracture types are simplifi-ed,personalized and safer by using 3D printing technology.