X线下经皮平行克氏针内固定治疗老年股骨颈骨折256例

To explore the therapeutic effectiveness in senile patients with femoral neck fractures treated by x-ray-guided internal fixation with Kirschner percutaneous parallel pin

目的 探讨老年人股骨颈骨折在X线下经皮平行克氏针内固定的疗效。方法 患肢牵引 ,在透视下复位良好后局麻达骨膜 ,股骨大粗隆下 3～ 4cm ,用直径 2 .5mm克氏针透视下钻入 ,然后在其上方 1～ 3cm平行第 1根钻入第 2根 ,对位良好后呈棱形钻入第 3根 ,第 4根。克氏针距股骨头关节面下约 0 .5～ 1.0cm ,皮肤不缝合。结果 随访 6个月～ 8年 ,术后拍X线平片 ,平均愈合时间 3～ 5个月。 6个月拔针。 6个月后骨折线消失 ,10个月后关节活动正常的 170例 ,6～ 10个月骨折线消失 ,1年内髋关节活动正常 76例 ,跛行并关节活动受限的 10例。出现股骨头无菌坏死的 2例。结论 由于老年人体质相对较差 ,对创伤较大手术耐受力下降者 ,采用透视下经皮平行克氏针内固定治疗老年人股骨颈骨折 ,有创伤小 ,操作简便 ,手术时间短 ,愈后良好的优点。

Objective To explore the therapeutic effectiveness of fracture of neck of femur of the old therapied with parallel internal fixation with Kirschner pins under X-rays. Methods traction of the wounded limb, anaesthetized locally to the periost after good reduction. Use Kirschner pins(D=2.5mm) to punch the femur,3 to 4cm down to the trochanteric of femur.Then punch the first one and second one parallely, 1-3cm up to it ,and the third ,the fourth like rhomboid .The Kirschner pins were 0.5-1.0cm to articular surface of head of femur without suture. Results With six months to eight years followed the average up, healing time is 3～5months,170 patients' articulation can move feely after 10 months and fracture line disappeared when the pins were removed after 6 months. 76 patient' articulation can move freely in a year and fracture line disappeared after 6 to 10 months . 10 patients were founded claudication or limited action.2 patients were founded aseptic necrosis of head of femur. Conclusoion Since senile patients are general asthenia and can hardly tolerate surgery, the x-ray-guided parallel internal fixation with Kirschner pins is a good choice to the senile patients. And the advantages of this kind of treatment is less trauma, simply operation and favourable prognosis.