| BackgroundFracture of the femoral head was caused by the high energy damage.Fracture of the femoral head is a very special and serious injury.In general, the small incidence of femoral head fracture. The pure femoral head fracture clinically more rare. In recent years, with the industrial accidents and traffic accidents increased year by year. The incidence of bone fracture rate also showed a rising stock. Femoral head fractures often associated with severe hip injury. Often secondary to traumatic posterior dislocation of hip joint of femoral head fracture. Femoral head fracture anatomical structure is very special, the mechanism of injury is special. The surgical treatment is very difficult, resulting in a poor prognosis. The femoral head fractures belong to intra-articular fracture. Some scholars think that the I / II type of femoral head fracture. Can be closed reduction. If the reset fails, then the non operative treatment. The analysis of some scholars, will cause the risk of surgical treatment of femoral head necrosis increased.The type of femoral head fractures is very complex.The quality of bone fracture patients bone of femoral, fracture type, and selected different operative methods, the difference may cause the prognosis function of patients. According to individual differences, using different approaches. The common approach is the anterior approach and posterior approach. Early anatomical reduction, bone block fixation, hip continuous reconstruction, ossicle removal is the treatment principle of the femoral head fractures. At present,the treatment of femoral head fractures are mainly four kinds of methods: closed reduction. The excision of fracture fragments. The open reduction and internal fixation. The joint replacement. Among them. Open reduction and internal fixation is one of the most feasible way. Early femoral head fracture fixation and reduction can obtain the expected positive effect. Femoral head fractures associated with dislocation of hip joint, femoral neck fracture, often associated with acetabular fracture. In the femoral head fracture incidence increased year by year the situation, orthopedic surgeons for different types of fractures of the femoral head, in choice of treatment methods, how the surgical approach, surgical approach, fixed materials scheme, optimization and upgrading of shares of bone fracture curative effect, there is still need to be further research. Therefore, the femoral head fracture clinical data and influence factors associated with surgical treatment were retrospectively analyzed. Department of orthopedics physicians will deepen the understanding of femoral head fracture. It is of great significance for improving the clinical curative effect of femoral head fracture. ObjectiveThrough the analysis and retrospective review of the literature,To explore the various factors related to the surgical treatment of femoral head fractures.In order to summarize the experience, for the clinical treatment of femoral head fractures, provide reasonable reference operation mode and improve the effect of surgical treatment. Methods 1 MaterialsRandomly selected from October 2011 to December 2015 of 0Zhengzhou University First Affiliated Hospital because of fracture of the femoral head patients as the research object.86 cases of the fracture of the femoral head patients clinical data was analyzed retrospectively.There were 56 males and 30 females. Age 16~44 years old, average age(30.35±12.73). For 64 cases of injuries caused by traffic accidents. Falling injury in 22 cases. On the left side in 50 cases, 36 cases of right. Were closed injury. 15 cases with thoracic abdominal visceral injury. 30 cases of craniocerebral injury. The sciatic nerve injury in 10 cases. Other parts of fracture in 31 cases. According to the Pipkin classification: 30 cases of type I, 8 cases of dislocation of hip joint. There were 27 cases of type II, 14 cases combined with posterior dislocation of the hip. Type III in 17 cases, 15 cases of dislocation of hip joint. 12 cases of type IV, 3 cases of anterior dislocation, 6 cases with dislocation of the hip, with the ipsilateral sciatic nerve injury in 3 cases. 2 MethodsA retrospective analysis of the First Affiliated Hospital of Zhengzhou University form October 2011 to December 2015, 86 cases of patients with femoral head fracture clinical data was collected. According to the age, type of Pipkin, severity and preoperative imaging combined with intraoperative exploration considering. A reasonable choice of treatment method. Operation time: the time from injury to 8h~26d, the average time(12.32±4.21)d. The 12 h surgery in 7 cases. 56 cases of 12~48h patients. More than 23 cases of 48 h patients. Operation method: PipkinI: using S-P approach. 5 cases of removal of small fragments, and with absorbable screw large bone, 19 cases of simple small fragments removed. Pipkin type: the K-L approach in 12 cases, S-P in 18 cases. Large bone block with absorbable screw fixation in 16 cases, titanium alloy screw fixation in 4 cases. Enucleated not fixed small fragments. Pipkin type: the K-L approach. Are the use of absorbable screws. Femoral neck fracture, fixation with titanium cannulated screws. Pipkin type: the combined approach in 4 cases. Using the K-L approach in 7 cases. 4 cases were treated with titanium alloy screw fixation. 9 cases were treated with absorbable screw fixation. For acetabular fracture with reconstruction plate. The postoperative follow-up of curative effect, and give the evaluation record..All the patients were followed up for 14~50 months in 86 cases of patients with fracture of the femoral head, the average(30.35±13.27) months. 4 cases of traumatic arthritis, 3 cases of femoral head necrosis, no heterotopic ossification. No fracture fixation failure, infection and dislocation. 3~6 months, 25 cases of limb full weight-bearing. 61 months of 6 cases of limb full weight-bearing. The average time of full weight-bearing limb after surgery in this group is(30.76±12.63) weeks. According to Thompson-Epstein standard. To evaluate the efficacy of surgical treatment. Results:17 cases were excellent(9 cases, 5 cases of type I, type II and type IV 3 cases). Good in 42cases(18cases, 15 cases of type I, 2 cases of type II and III type IV 7 cases). In 23cases(3cases,7 cases of type I, 12 cases of type II and III type IV1 cases). Poor in 4 cases(3 cases, 1 cases of type III type). The excellent rate was 68.60%(59/86).Comparison between classification and treatment effect of Pipkin fractures: type I good rate was 90%(27/30) type II, the excellent rate was 74.07%(20/27), type III excellent rate was 11.76%(2/17), type IV excellent rate was 83.33%(10/12). The difference was statistically significant(?2=15.452, P<0.05).Comparison between different operation time and therapeutic effect of 12 h in the excellent rate was 85.71% and the excellent and good rate of 12~48h was 71.43%, the excellent rate was 47.83% more than 48 h. The difference was statistically significant(?2=7.452, P<0.05).To compare the different relationship between surgical approach and curative effect in the treatment of the excellent rate: the road into the excellent rate of S-P was 88.00%, the K-L approach was 67.33%, 25.00% for the combined approach.The difference was statistically significant(?2=12.226, P<0.05).Comparison of different surgical methods and treatment efficacy rate: titanium alloy screw fixation, simple small bone block resection, absorbable screws fixed rate were 83.33%,80.00%,84.38%.There was no statistically significant difference(?2=3.315, P>0.05). Comparison between different postoperative full weight-bearing time and Results excellent therapeutic effect rate: 3~6 months the excellent rate was 52.00% and 6 months after the 77.05%. The difference was statistically significant(?2=9.237, P< 0.05). Conclusion1 Type Pipkin fracture has obvious impact on the effect of surgical treatment. typeI, type II and IV fractures can obtain better results of surgical treatment. But the fracture of surgical treatment for patients with poor results.2 The operation time has significant effect on surgical treatment. Patients who received surgery excellent higher rate of 12 h fracture. However, the number of cases in this group 12 h received surgical treatment is comparatively less, investigation and analysis of the exact conclusion still need large sample.3 The difference has obvious curative effect in the treatment of different road and the excellent rate of operation. The S-P approach and K-L approach for surgical treatment are better than the combined approach of the excellent rate. Analysis of its causes, and combined approach of fractures in patients with severe injury and long operation time related.4 The absorbable screws and simple small broken bone removal or titanium alloy screws fixed three operation on the therapeutic effect of no significant difference.5 Postoperative full weight-bearing time has a certain influence on the curative effect, postoperative surgical treatment effect of weight after 6 months was significantly higher than that in patients with 3~6 months postoperative weightbearing. |
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