切开与闭合复位治疗股骨颈骨折的疗效比较

A Comparison Study on Open and Closed Reduction Plus Cannulated Screws System for Femoral Neck Fractures

目的探讨股骨颈骨折采用闭合复位空心钉固定与切开复位空心钉固定的临床效果。方法对2002年7月至2006年1月收治的72例股骨颈骨折患者进行分析。其中随访资料完整的70例中,Garden型10例,型22例,型38例。平均随访时间28个月。结果70例患者中65例愈合,总愈合率为92.9%,其中闭合复位组39例骨折愈合,3例骨折不愈合,愈合率为92.9%;切开复位组26例骨折愈合,2例骨折不愈合,愈合率为92.9%。8例出现股骨头坏死,坏死率为11.4%。其中采用闭合复位加空心钉固定患者42例,5例出现股骨头坏死,坏死率为11.9%;采用切开复位空心钉固定28例,3例出现股骨头坏死,坏死率为10.7%。结论股骨颈骨折所致股骨头坏死和骨不连的发生与骨折的类型及治疗方法的选择有关。良好的复位加空心钉固定可达理想的治疗效果。股骨颈骨折切开复位内固定与闭合复位内固定术后的股骨头坏死或骨不连的发生率无明显差异,也可能与本研究病例少,随访时间短有关,但骨折的解剖复位和坚强的内固定仍是骨折愈合的关键因素。

Objective To compare the clinical results of open and closed reduction plus cannulated screw stystem for femoral neck fractures.Methods A study was carried out in 70 cases of femoral neck fractures treated from July 2002 to January 2006,of whom there were 10 cases of type GardenⅡ fractures,22 type GardenⅢ and 38 type Ⅳ.All cases were followed up for average 28 months.Results Nonunion fractues occurred in 5 cases with union rate of 92.9%,femoral head necrosis in 8 cases with a necrosis rate of 11.4%.Of 42 cases with closed reduction plus cannulated screw,3 cases resulted in nonunion with union rate of 92.9%,5 cases suffered from femoral head necrosis with necrosis rate of 11.9%.Of 28 cases with open reduction plus cannulated screw,2 cases resulted in nonunion with union rate of 92.9%,3 cases suffered from femoral head necrosis with necrosis rate of 10.7%.Conclusion The femoral head necrosis and the nonunion of femoral neck fractures relate to fracture type and trement methods.The better reduction plus cannulated screw fixation can obtain better clinical results.Open reduction plus cannulated screw fixation do not add the nonunion rate and femoral head necrosis rate.