Efficacy Analysis And Comparison Of Different Approaches In The Treatment Of Pipkin Femoral Head Fracture

Purpose:Femoral head fractures are a kind of rare fractures.There is much controversy about the surgical methods and surgical approaches for this type of fractures.At present,there is no unified treatment guideline.Among them,Pipkin type ? fracture,not only leads to femoral neck fracture,but also entails femoral head fracture.The necrosis rate of femoral head following operation is high,and its prognosis is much more undesirable.Pipkin ? fractures often result in the complications of larger acetabular posterior wall fractures or pelvic fractures,and often need to be treated by combined approach,which leads to more uncertainties.Therefore,on account of the Pipkin ?,? on this category of rare fractures,we followed up postoperative patients and summarized these cases to compare the postoperative curative effects,prognoses,etc.among the different surgical approaches for the treatment of femoral head fractures.The result has been statistically analyzed and arranged in order to hope it can play a certain reference role for the surgery program on this kind of fractures,and increase the efficacy.Materials and Methods:We retrospectively analyzed 25 cases from patients(19 in men and 6 in women)who were diagnosed with "femoral head fracture" and received treatments in our department from August 2014 to October 2017.These patients range in age from 27 to 60 with an average age of 44 ±10.9 cases belong to Pipkin type ?,and 16 cases belong to Pipkin ?.The patients were followed up for 6-28 months with an average of 18 months.There were 10 cases of posterior K-L approach,3 cases of Ganz approach,5 cases of anterior S-P approach and 7 cases of modified Heuter approach.Patients were treated with internal fixation of countersunk hollow compression screws,including 3 patients in absorbable material screws,and the other in titanium alloy screws.Routine antibiotics were used to prevent infection after operation,along with the guidance of rehabilitation exercises of hip joint.Patients in the K-L and Ganz approaches with posterior lateral approach were classified as Group A,and patients in the anterior approaches(S-P,Heuter Approach)were classified as Group B.The comparative data were: operation time,intraoperative blood loss,postoperative complications,fracture healing time,complete weight-bearing time.Harris scoring system was assumed in Hip function evaluation,and Thompson-Epstein scoring system in imaging criteria.We used statistical analysis software SPSS 21.0 for statistical analysis,and carried out a comprehensive evaluation and comparison of the surgeryefficacy between two groups.Result:All patients received a complete follow-up which took 18 months in average.In the patient postoperative review,X-ray showed that all femoral head fractures received anatomical reduction.Among them,patients in the anterior approach were classified as Group A,and patients in the posterior approach were classified as Group B.According to the analysis of SPSS,the variables of two groups including age,gender,injury mechanism,fracture type,etc.have no statistical significance.In the last postoperative follow-up,the result of hip function is as follows.Group A were assessed and classified as excellent(7),good(4)and fair(1),and its good rate reached 91.7%;Group B were assessed and classified as excellent(1),good(6)and fair(6),and its good rate reached 53.8%;The result of the rank sum test is as follows.Z =-2.062,p = 0.039(less than 0.05,with statistical significance)The result of the independent sample T test on the comparative data(operation time,intraoperative blood loss,postoperative complications,fracture healing time,complete weight-bearing time)of two groups is that the anterior approach is better than the posterior approach in the aspects ofoperation time,and intraoperative blood loss.In addition,as for the complications,the probability of ONFH(Osteonecrosis of the Femeral Head)in posterior approach is higher than it in anterior approach,and the probability of HO(Heterotopic ossification)in anterior approach is higher than it in posterior approach.Conclusion:The hip joint is the most important weight-bearing joint in the body,and the bilateral femoral heads bear most of the body's pressure.Femoral head fractures usually occur in young adults,often accompanied by dislocation of the hip joint and acetabular fractures,which are mostly high-energy damages.Clinical studies have confirmed that the vast majority of femoral head fractures need surgeries to restore the integrity of the femoral head articular surface.Conservative treatment is only applicable to the femoral head fracture with no displacement or displacement of less than 2 mm,in addition to the need for the good hip stability,the stable relation between the femoral head and the acetabulum,no free blade of bone within the joint.Femoral head fracture patients who simultaneously have acetabular or pelvic fractures are advised to use a combined approach to fix the pelvis and femoral head fractures,and take care to protect the nutrient arteries of femoral head in the meantime.For a mere femoral head fracture or a minor acetabular posterior wallfracture,the anatomical reduction doesn't affect the stability of the joint.At this moment,the anterior approach is better than the posterior approach for less damage,simple exposed vision,less postoperative complications,well-preserved hip function,smaller femoral head necrosis and other advantages.