空心加压螺纹钉治疗股骨颈骨折

Treatment of femoral neck fracture by cannulated compression screws

目的 :探讨空心加压螺纹钉治疗股骨颈骨折的疗效、手术适应证及最佳手术方式 .方法 :回顾分析 84例经闭合复位、小切口 (约 5cm)空心加压螺纹钉内固定治疗的股骨颈骨折患者的临床资料 ,随访观察术后并发症及髋关节功能恢复情况 ,按Harris髋部评分 (HHS)进行临床评估 .结果 :随访 1 .5～ 7(平均 3.7)a ,所有病例均未出现伤口感染 ,下肢深静脉血栓 ,膝关节僵硬及内固定断裂现象 ,也未发生与手术相关的死亡病例 .8例 (8/ 84 ,9.5 % )出现不同程度的股骨头坏死 ,其中 6例关节功能良好 ,日常生活无明显影响 ,2例关节疼痛较重 ,行人工关节置换 ;4例 (4 / 84 ,4 .8% )术后发生骨折移位、骨折不愈合 ,已行人工关节置换术 .术后无并发症患者Harris髋关节功能评分平均 91 .8分 .结论 :闭合复位、小切口空心加压螺纹钉内固定是治疗股骨颈骨折的有效手段 ,具有微创、安全实用、固定牢靠的优点 ,其适应于年龄 <70岁 。

AIM: To investigate the clinical result, indications and the optimum operation manners of using cannulated compression screws in the treatment of femoral neck fractures. METHODS: The authors retrospectively analyzed clinical data of 84 patients with femoral neck fractures treated by closed reduction, small skin incision and internal fixation by cannulated compression screws. We observed the postoperative complications and evaluated the functional outcomes of the hip joint according to Harris Hip Score(HHS). RESULTS: The follow up period ranged from 1.5 to 7 years with a mean of 3.7 years. No wound infection, deep venous thrombosis of leg and breakage of internal fixation occurred and no patient died of the operation. The latest follow up found that 8 of the 84 patients developed different degrees of osteonecrosis and 4 patients had nonunion of the fracture. The mean postoperative Harris hip score was 91.8 in patients who had no complications. CONCLUSION: Closed reduction, small skin incision and internal fixation with cannulated compression screws is an effective, safe and inexpensive method of minimal invasion and good internal fixation in treating femoral neck fracture. This method can be used for any types of femoral neck fracture in patients below 70 who have no severe osteoporosis.