青壮年股骨颈骨折三种内固定方式的疗效评价

Assessment of therapeutic effect of three internal fixations for the young patients with femoral neck fracture

目的：比较应用不同内固定方法治疗青壮年股骨颈骨折的临床效果,探讨手术时机、内固定方法对复位质量的影响。方法：青壮年股骨颈骨折患者112例,其中男60例,女52例;年龄17-50岁,平均43.5岁。骨折部位：头下型29例,经颈型49例,基底型34例;骨折程度（Garden分类）：Ⅰ型5例,Ⅱ型30例,Ⅲ型46例,Ⅳ型31例。骨折至手术时间：〈7d者76例,7-14d者25例,〉14d者11例。采用双头加压螺纹钉内固定34例（A组）,斯氏针固定37例（B组）和空心加压螺钉内固定41例（C组）。术后比较3组疗效及骨折复位情况和愈合率。结果：所有病例经1年2个月-10年6个月,平均3年10个月的随访。按张少成疗效评定：A组优良率70%（24/34）;B组优良率75.6%（28/37）;C组优良率80%（36/41）。股骨头坏死与骨折不愈合：A组29%（10/34）;B组26.4%（9/37）;C组19.5%（8/41）。3组优良率、股骨头坏死和骨折不愈合率差异无统计学意义（P〉0.05）。但复位质量、手术时机与股骨头坏死和骨折不愈合密切相关（P〈0.05）。结论：早期正确的解剖复位,坚强有效的内固定是治疗青壮年股骨颈骨折的关键。空心加压螺钉优于斯氏针,斯氏针优于双头加压螺钉。

Objective： To compare the therapeutic effect of different kinds of internal fixations for the young patients with femoral neck fracture and explore the effect of operation juncture and different internal fixations on the reduction quality. Methods： There were 112 young adults （60 male and 52 female,aged 17 to 50 years,averaged 43.5 years） with femoral neck fracture. These patients were treated by three different kinds of internal fixations respectively. Fracture site was infer-head in 29 cases, per-neck in 49 and fundament-form in 34. According to Garden typing, there were 5 cases of type Ⅰ, 30 of type Ⅱ,46 of type Ⅲ and 31 of type Ⅳ. The course of 76 cases were less than 7 days, that of 25 cases were during 7 to 14 days, that of 11 cases were more than 14 days. Thirty-four cases were treated hy both-ends screwed compression nail （A） ,37 cases by Steinmann pin （B） and 41 eases by cannulated compression screw （C）. The reduction extent and healing rate were assessed with ZHANG Shao-cheng criteria and X-ray radiology among three groups. Results ： All cases were followed up for one year and two months to ten years and six months with average of three years and ten months. The clinical therapeutic effect was assessed, the excellent and good rate was 70% （24/34） in group A,75.6% （28/37） in group B and 80% （36/41） in group C. The incidence of femur head necrosis and nonunion was 29% （ 10/34 ） in group A ,26. 4% （9/37） in group B and 19.5% （ 8/41 ） in group C. In regard to excellent and good rate, incidence of femur head necrosis and nonunion fracture, there were not significantly different among three groups （ P 〉 0.05 ）. But reduction quality and operation time were closely related to femur head necrosis and nonunion fracture （P 〈 0. 05 ）. Conclusion： Early and correct anatomic reduction and strong internal fixation is key measures to treat the young patients with femoral fracture. The therapeutic effect of cannulated compression screw is better than that of Steinmann pin, that of Steinmann pin is better than that of both-ends screwed compression nail.