空心钉治疗老年股骨颈骨折中远期疗效观察

Femoral Neck Fracture Treatment by Cannulated Screw Internal Fixation in Elderly Patients

目的评价老年股骨颈骨折空心钉内固定预后的影响因素,内固定治疗老年股骨颈骨折的可行性。方法空心钉经皮手术内固定治疗老年股骨颈骨折52例,男17例;女35例。年龄60～89岁,平均70.75岁,无移位骨折(GardenⅠ型、Ⅱ型15例;移位骨折(GardenⅢ型、Ⅳ型)37例,随访时间:12～58个月,平均31.40个月。观察内容包括受伤至手术的时间移位程度,术后早期负重及与年龄的关系。结果无移位股骨颈骨折,骨折不愈合及股骨头缺血坏死发生率为0.00%,移位骨折,不愈合及股骨头缺血坏死分别占8.11%(3/37)和5.41%(2/37)。伤后至手术时间超过3周,骨折不愈合的发生率增高至66.67%(2/3)。结论如能术前掌握好适应证,术后给予正确的康复指导,老年人股骨颈骨折内固定治疗大多数效果良好。

Objective To study the factors that influence the outcome of the femoral neck fractures after fixed by cannulated screws, and the possibility of internal fixation as one of the useful methods in the treatment of femoral neck fractures. Methods Fifty- two elderly patients with femoral neck fractures were treated with percutaneous cannulated screw fixation. Their average age was 70.75 years （range, 60-89yesrs）. Fifteen cases were femoral neck fractures with no displace （Garden Ⅰ ,Ⅱ）. Thirty - seven cases were displaced （Garden Ⅲ ,Ⅳ）. The time to surgery, initial fracture displacement, weight bearing and age were recorded. The average follow up time was 31.40 months （12-58 months）. Results The rate of nonunion and avascular necrosis was 0.00% in the femoral neck fractures with no displace, while it was 8.11% （3/37） and 5.41 % （2/37） respectively in the displaced femoral neck fractures. The nonunion rate increased to 66.67% when the operation was delayed more than 3 weeks. Conclusion The outcome of internal fixation of femoral neck fractures is good in the majority of elderly patients. The indications should be mastered before operation and rehabil exercise guidance should be given postoperatively.