Hip & pelvis

The Korean Hip Society (대한고관절학회)
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Treatment of Traumatic Posterior Dislocation of the Hip Joint Associated with Femoral Head Fracture

대퇴 골두 골절과 동반된 외상성 고관절 후방 탈구의 치료

  • Park, Myung-Sik (Department of Orthopedic Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital) ;
  • Park, Jong-Hyuk (Department of Orthopedic Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital) ;
  • Kim, Do-Yeoun (Department of Orthopedic Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital) ;
  • Cho, Hong-Man (Department of Orthopedic Surgery, Daejon Veterans Hospital)
  • 박명식 (전북대학병원 정형외과학교실) ;
  • 박종혁 (전북대학병원 정형외과학교실) ;
  • 김도연 (전북대학병원 정형외과학교실) ;
  • 조홍만 (대전 보훈병원 정형외과)
  • Published : 2010.12.31
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Abstract

Purpose: This study examined the treatment of patients with posterior hip dislocation and femoral head fracture, according to the Pipkin classification, and we analyzed their clinical and radiological results. Materials and Methods: The subjects consisted of 45 patients who were treated for posterior hip dislocation and femoral head fracture. The subjects had an average age of 39, and 38 were men and 7 were women. The average follow-up period was 33 months. The cause of injury was traffic accident in 41 cases and falling for the other four cases. According to the classification, there were 26 Type I cases, 5 Type II cases, 1 Type III case and 13 Type IV cases. The treatment methods were selected according to the patients' condition and the form of fracture. The Ebstein criteria and the Merle d'Aubigne and Postel score were used to determine whether there was a combined injury and to examine the clinical and radiological results. Results: All the cases classified as Type I, II and III showed good or excellent clinical results. A primary osteosynthesis was performed on the Type III cases according to the patient's age and condition, with particularly good results. An anatomical reduction in the early stages affected the clinical results of the Type IV cases. The observed complications were posttraumatic osteoarthritis (38.4%) and avascular necrosis (15.3%). Conclusion: The prognosis was determined by the injury's initial severity, the time for reduction and the anatomical reduction and firm fixation of the femur and the fracture fragment of the acetabulum.

목적: 대퇴 골두 골절이 동반된 외상성 고관절 후방탈구 환자에서 Pipkin 분류에 따른 치료 및 임상적, 방사선학적 결과에 대하여 알아보고자 하였다. 대상 및 방법: 대퇴 골두 골절을 동반한 후방 탈구로 치료한 45명을 대상으로 하였다. 수상 당시 평균 연령은 39.6세(17~71세)였으며 남자가 38예, 여자가 7예 였고, 추시 기간은 평균 33개월 (19.2~84개월)이었다. 수상의 원인으로 교통사고가 41예, 낙상이 4예로 Pipkin I형이 26예(57.8%), Pipkin II형 5예 (11.1%), Pipkin III형 1예(2.2%), Pipkin IV형 13예(28.9%)였다. 환자의 상태와 골절의 형태에 따라 치료 방법을 선택하였으며 환자의 동반손상 여부와 임상적 방사선학적 결과를 Ebstein criteria와 Merle d'Aubigne'& Postel score로 평가 하였다. 결과: PipkinI,II,III 형은 전례에서 양호 또는 우수한 임상 결과를 보였다. 특히 Pipkin III형은 환자의 연령과 상태에 따라 일차적인 골유합술을 시행하여 좋은 결과를 얻을 수 있었다. Pipkin IV 형은 조기의 해부학적인 정복이 임상 결과에 영향을 주었으며, 합병증으로 외상성 관절염 (38.4%)과 무혈성 괴사(15.3%)가 발생 되었다. 결론: 수상 당시의 손상 정도와 정복 시기 및 대퇴골과 비구의 골절편에 대한 해부학적 정복과 안정적인 고정이 예후에 영향을 주었다.

Keywords

References

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