Efficacy Of Treatment Femoral Head Fracture With Anterior Approach And Posterior Approach

Objective:To compare the clinic effects of anterior approach and posterior approach, in treatment of fracture of the femoral head in order to provide evidence for clinical choice.Methods:We reviewed 42 patients were treated in our hospital due to femoral head fracture between June 2002 and April 2010, 29 fractures were Pipkin types I and II. 13 fractures were Pipkin types III and IV. Patients in Pipkin types I and II were divided into A, B groups. A group: 14 cases were treated by anterior approach., which included Pipkin type I 5 cases, type II 9 cases, mean age, 43.3(range,18 to 58 years); Cause of injury: 2 cases were injured by heavy objects, 1 case was fall injury, and 11 cases were traffic accident. Surgery internal fixation: 11 cases were treated by internal fixation with tow to three 3.0mmAO Hollow screw, 3 cases were treated with cancellous bone screw, in which 2 cases were combined internal fixation with kirschner wire. B group: 15 cases were treated by posterior approach, which inclded Pipkin type I 6 cases, type II 9 cases; mean age, 40.1(range,19 to 51 years); Cause of injury: 1 case was injured by heavy objects, 3 cases were fall injury, and 11 cases were traffic accident. Surgery internal fixation: 12 cases were treated by internal fixation with tow to three 3.0mmAO Hollow screw, 3 cases were treated with cancellous bone screw, in which 3 cases were combined internal fixation with Kirsches wire. All fractures were closed fractures. All patients were posterior hip dislocations, and closed reduction Within 6 hours, Open reduction and internal fixation Within 12 to 72 hours. Statistically compared in terms of their surgery time, volume of operative bleeding, postoperative complications, as well as postoperative recovery in treatment of fracture of the femoral head.13 fractures were Pipkin types III and IV, which included 2 cases were Pipkin types III, 11 cases were Pipkin types IV. Mean age, 37.6(range, 23 to 66years). Cause of injury: 2 cases were injured by heavy objects, 3 cases were fall injury, and 8 cases were Traffic Accident. All patients were posterior hip dislocations, and closed reduction within 6 hours, 4 cases were used Emergency surgery, 2 cases were open reduction and internal fixation within one week, and 7 cases were open reduction and internal fixation within 12 to 72 hours. All patients were treated by posterior approach. In ord to analysis postoperative recovery in treatment of fracture of the femoral head, retrospective review was used.Results:Volume of operative bleeding: A groups 100-400ml,with a mean (176.42±85.08)ml,B groups 100-600ml,with a mean (264.67±131.25)ml,there were significant differences between the two treatment groups (P < 0.05); surgery time: A groups 60-120min,with a mean(87.14±20.54)min,B groups 120-180min,with a mean (148±33.2)min, there were significant differences between the two treatment groups (P < 0.05)。Pipkin types I and II: The follow-up time ranged from 1 to 5 years, with a mean follow-up of 2.8 years. In two groups, no failure of internal fixation.Good rate: A groups, After 6 months 92.8%(13/14 cases),After 12 months 100%(14/14 cases); B groups : After 6 months 93.3%(14/15cases),After 12 months 93.3%(14/15 cases); there was no significant difference between the two groups ( P > 0.05 )。postoperative complications: A groups 3 cases(21.4%),2 cases were heterotopic ossification, 1 case were traumatic arthritis; B groups :2 cases(13.3%),1 case was including heterotopic ossification, 1 case was Traumatic arthritis; there was no significant difference between the two groups(p>0.05).Pipkin types III and IV: The follow-up time ranged from 1 to 6 years, with a mean follow-up of 3.3 years. Harris Rating the after 12 months: Excellent 7 cases, Good 2 cases, Poor 4 cases.Conclusion:Pipkin type I,II femoral head fractures: With anterior approach and posterior approach, can achieve better clinical efficacy. With anterior approach, operation time was shorter and volume of operative bleeding less. The treatment of Pipkin type III,IV: With posterior approach, can facilitate the processing of acetabular posterior wall fracture and repair articular capsule easily.