经皮加压空心钉微创治疗老年新鲜股骨颈骨折

Minimally invasive treatment with percutaneous compressing cannulated screw for fresh femoral neck fracture in aged patients

目的探讨应用闭合复位、经皮加压空心钉技术微创治疗老年新鲜股骨颈骨折的疗效。方法对我科1997年5月至2005年12月间行闭合复位、经皮加压空心钉治疗的145例老年新鲜股骨颈骨折患者进行回顾性分析，按Garden分型：Ⅰ型7例，Ⅱ型54例，Ⅲ型78例，Ⅳ型6例。结果随访12～104个月，平均46．2个月。139例骨折愈合，6例骨不连，骨折愈合率95．9％。17例股骨头缺血坏死，坏死率11．7％。其中Garden Ⅳ型骨折愈合率83．3％，股骨头缺血坏死率66．7％。髋关节功能评价，优58例，良73例，差14例，优良率90．3％。结论闭合复位、经皮加压空心钉技术微创治疗老年新鲜股骨颈骨折具有创伤小、固定牢靠、可早期功能锻炼、骨折愈合率高等优点，但对Garden Ⅳ型骨折宜采用关节置换术。

Objective To evaluate the therapeutic effect of minimally invasive treatment on fresh femoral neck fractures in aged patients using closed reduction and percutaneous compressing cannulated screws. Methods Totally 145 aged patients with fresh femoral neck fractures treated during May 1997 to December 2005 were retrospectively analyzed. Seven cases were Garden type Ⅰ, 54 Garden type Ⅱ , 78 Garden type Ⅲ and 6 Garden type Ⅳ. Results The follow-up period tures in 139 cases recovered and bone nonunion was 12 - 104 months and the average was 46.2 months. Fracoccurred in 6 cases, with the fracture healing rate of 95.9%. Femoral head ischemic necrosis occurred in 17 cases （17/145, the ischemic necrosis rate of 11.7% ）. Wherein the fracture healing rate of Garden type Ⅳ fracture was 83.3% and the femoral head ischemic necrosis rate was 66.7%. The function evaluation of hip joint showed that excellent outcome in 58 cases, good outcome in 73 and poor outcome in 14. Conclusion Minimally invasive treatment with closed reduction and percutaneous compressing cannulated screws for fresh femoral neck fracture in aged patients has the advantages of minimal injury, stable fixation, early functional exercise and high fracture healing rate etc. However, hip joint replacement is suggested in managing fracture of Garden type Ⅳ.