AO螺钉经皮内固定治疗股骨颈骨折失败原因分析及对策

An Analysis of Failure Factors and Its Measures in Treatment of Femoral Neck Fracture with Close Reduction and Compressed Cannulate Screw Fixation

目的 探讨AO加压空心螺钉治疗股骨颈骨折失败原因及预防和处理措施。方法 总结 1998年 1月～ 2 0 0 3年 1月用AO加压空心螺钉治疗 92例股骨颈骨折的经验。对其中失败的 14例进行分类 ,分析相关原因及处理措施。结果 92例中有 14例失败 ,将其分为 6类 :导针头断裂、粉碎性骨折术后内固定不牢、螺钉穿出股骨头、螺钉松动、螺钉位置不良、骨折不愈合。患者年龄、骨折类型、供血和复位的影响 ,手术技术、手术适应证的选择不当是失败的相关原因。对策是取出断裂导针头、提前取钉、改用其它内固定方式或关节置换及相关病因的对症处理。结论 选择AO加压空心螺钉治疗股骨颈骨折应根据患者年龄、骨折类型掌握好适应证 ,正确的手术操作和手术技巧、准确复位及术后严格管理会使总体治愈率进一步提高 ,对高龄GardenⅣ型患者不宜首选。

Objective To analyse failure factors treating femoral neck fracture with close reduction and compressed cannulate screw fixation,how to prevent and treat them.Methods Ninety-two cases of femoral neck fracture were treated by close reduction and compressed cannulate screw fixation from Jannuany 1998 to Jannuary 2003,of them 14 cases were failure.The failure cases were analysed to find out the factors and its measures.Results Failure factors were divided into 6 types:there were fragement of the head of guide pin,comminuted fracture,perforation of screw to femur head outward,screw loosen,misplacement of screw,and nounion of fracture.Failure relative factors were regarded to age,type of fracture,influence of blood-supply and correcting dislocation,operation technique and choice of operative indication.Measures of therapic failure were pulling out fragment of the head of guide pin,pulling out screw ahead of schedule,using other fixation or total hip replacement.Conclusion Using close reduction and AO compressed cannulate screw fixation to treat femoral neck fracture must be on the basis of age,type of fracture,operation technique and administration after operation.It should not be the first choice for treatment of old patient with Garden Ⅳ.