不同时间和复位方法空心钉内固定治疗移位股骨颈骨折术后骨折愈合的比较

COMPARISON OF CANNULATED SCREWS FIXATION WITH DIFFERENT REDUCTION METHODS AT DIFFERENT TIME POINTS FOR DISPLACED FEMORAL NECK FRACTURES IN TERMS OF FRACTURE HEALING

目的比较不同时间和采用不同复位方法行空心钉内固定治疗移位股骨颈骨折术后骨折愈合质量。方法1997年1月-2007年9月,收治240例移位股骨颈骨折患者。男121例,女119例;年龄22～79岁,平均56岁。均为新鲜闭合性骨折。骨折根据部位分型:头下型133例,经颈型64例,基底型43例。根据Garden骨折分型,Ⅲ型105例,Ⅳ型135例。全部患者接受空心钉内固定,伤后至手术时间6h～7d。急诊行闭合复位内固定55例,有限切开复位内固定59例;择期行闭合复位内固定65例,有限切开复位内固定61例。比较骨折愈合率、复位优良率及固定优良率。结果闭合复位及有限切开复位手术时间及出血量差异无统计学意义(P>0.05)。术后所有患者切口均Ⅰ期愈合,无感染发生;股骨头缺血性坏死44例,其中急诊有限切开复位内固定组坏死率低于其余3组(P<0.01)。所有患者术后均获随访,随访时间12～72个月,平均38个月。193例骨折愈合,愈合时间10～23个月,平均14个月。急诊闭合复位内固定组骨折愈合率、复位优良率及固定优良率分别为74.55%、73.73%、76.36%,急诊有限切开复位内固定组分别为91.53%、94.92%、93.22%,择期闭合复位内固定组分别为69.23%、70.77%、73.85%,择期有限切开复位内固定组分别为86.89%、91.80%、88.52%。有限切开复位内固定组骨折愈合率、复位优良率及固定优良率均高于闭合复位内固定组(P<0.01),急诊手术组与择期手术组比较差异无统计学意义(P>0.05)。结论复位方式对空心钉内固定治疗移位股骨颈骨折术后骨折愈合有显著影响,手术时间对骨折愈合影响不明显。

Objective To compare the therapeutic effect of cannulated screws fixation at different time points through different reduction methods on the heal ing of displaced femoral neck fractures. Methods From January 1997 to September 2007, 240 patients with displaced femoral neck fracture were treated, including 121 males and 119 females aged 22-79 years old （average 56 years old）. All cases were fresh and close fractures. According to the fractured part, there were 133 cases of subcapital fracture, 64 of transcervical fracture and 43 of basal fracture. According to Garden classification, there were 105 cases of type III and 135 of type IV. Cannulated screws fixation was performed on all the patients, and the time from injury to operation was 6 hours to 7 days. Fifty-five cases received closed reduction and 59 cases received l imited open reduction as emergency treatment, while 65 cases received closed reduction and 61 cases received l imited open reduction as selective operation. Different groups were compared in terms of the heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation. Results There was no significant difference between the closed reduction and the l imited open reduction in terms of operation time and bleeding volume （P 〉 0.05）. Postoperatively, all wounds healed by first intention, no infection was observed, avascular necrosis of femoral head occurred in 44 cases, and the rate of avascular necrosis of femoral head in the l imited open reduction at emergency group was less than that of other 3 groups （P 〈 0.01）. All the patients were followed up for 12-72 months （average 38 months）, 193 cases got fracture heal ing at 10-23 months after operation （average 14 months）. For the closed reduction as emergency operation group, the l imited open reduction as emergency operation group, the closed reduction as selective operation group, and the l imited open reduction as selective operation group, the heal ing rate of fracture was 74.55%, 91.53%, 69.23% and 86.89%, respectively; the excellent and good rate of reduction was 73.73%, 94.92%,70.77% and 91.80%, respectively; the excellent and good rate of fixation was 76.36%, 93.22%, 73.85% and 88.52%, respectively. The heal ing rate of fracture, the excellent and good rate of reduction as well as the excellent and good rate of fixation in the l imited open groups were higher than that of the closed reduction groups （P〈 0.01）, and there was no significant difference between the emergency operation groups and the selective operational groups （P〉 0.05）. Conclusion The reduction methods have significant influences on the heal ing of fractures after cannulated screws fixation of the displaced femoral neck fracture, and the operation time has no obvious effect on fracture healing.