手术治疗股骨距碎裂的股骨颈骨折

Operative management of femoral neck fracture with calcar comminution

目的 探讨股骨距碎裂的股骨颈骨折的手术方法及疗效。方法 手术治疗14例股骨距碎裂的股骨颈骨折患者，5例骨折无明显移位者行闭合复位折断式加压螺钉内固定；5例移位明显者术中将其切开复位后行股方肌骨瓣移植加空心加压螺纹钉内固定；4例行骨水泥型人工关节置换，其中2例去除股骨距骨块。结果 14例获9个月～3年随访。前两种术式中9例股骨距骨折块达骨性愈合，闭合复位组中1例变成死骨；股骨颈骨折均愈合；发生股骨头坏死1例。行骨水泥型人工关节置换的4例中2例保留的股骨距骨块愈合，1例出现假体松动。结论 合并股骨距碎裂的股骨颈骨折年龄较轻者应选择骨折复位内固定，老年患者则可选择人工关节置换，尽量保留股骨距的骨块。

Objective To study the methods and effects of operation on femoral neck fracture with calcar comminution. Methods 14 cases of femoral neck fracture with calcar comminution were operated. Among them, 5 cases of undisplaced fractures were treated with close reduction and breaking compression screw fixation; 5 cases with dis- placed calcar femoral bone flap were undergone open reduction with quadratus femoris muscle pedicle bone graft and cannulated screw fixation. 4 cases were treated with cemented hip replacement, of which calcar femoral bone flap were removed in 2 cases. Results 14 cases were followed up for 9 months - 3 years. 9 cases with calcar comminution treated with first two types of operation methods got union, and l got avascular necrosis in the close reduction group. All femoral neck fracture got union, and 1 was complicated with femoral head necrosis. In 4 cases with cemented hip replacement, 2 cases reserved calcar femoral bone flap got union, and 1 hip prosthesis had loosen. Conclusions The rate of femoral neck fracture with calcar comminution is lower. The fracture reduction and internal fixation must be selected in young adults, while cemented arthroplasty is used in the elderly, and calcar femoral bone flap is reserved as possible.