青壮年股骨颈骨折手术治疗的回顾性分析

Treatment of femoral neck fractures in young adults

目的探讨治疗青壮年股骨颈骨折的手术方法及临床疗效。方法对2005年1月至2008年6月行手术治疗并获得随访的41例青壮年股骨颈骨折患者按照“难治性骨折的治疗研究随访表”进行随访，从骨折类型、手术时机、骨折复位质量、置入物类型、卧床时间以及髋关节功能等方面进行评估。结果41例患者获得10～52个月随访，平均30．5个月。37例（90．2％）患者在伤后2～5d内行手术治疗，平均3．6d，GardenⅡ、Ⅲ型骨折采用闭合复位钛合金空心钉内固定术，GardenⅣ型及陈旧性骨折、病理性骨折采用切开复位钛合金空心钉内固定加髂骨瓣植骨术。术中复位评价平均4．83分，术后平均卧床时间3．5个月。髋关节功能按照Harris评分标准：优21例，良15例，可3例，差2例，优良率为87．8％。Garden Ⅳ型骨折优良率较Ⅱ、Ⅲ型骨折优良率低，但差异无统计学意义（X^2=1．35，P=0．25）。结论早期手术、解剖复位、多枚钛合金空心钉坚强内固定是青壮年股骨颈骨折手术治疗的关键，Garden Ⅳ型骨折髂骨瓣植骨、合理的早活动和晚负重是预防股骨头缺血坏死的有力保证。根据骨折的严重程度制定科学规范的治疗方案和合理的术后康复策略，对提高临床疗效具有极其重要的意义。

Objective To explore the surgical procedures and efficacy for femoral neck fractures in young adults. Methods 41 young adults with femoral neck fracture were treated in our department from January 2005 to June 2008 and were followed up according to the research standards for refractory fractures. Close reduction and internal fixation with titanium cannulated screws were adopted for Garden types Ⅱ ＆Ⅲ. Open reduction and internal fixation with titanium cannulated screws plus iliac grafting were adopted for Garden type IV and obsolete and pathologic fractures. The clinical efficacy was evaluated in terms of fracture type, implants, fracture reduction, postoperative bed-ridden time and hip functional recovery. Results All the 41 cases were followed up for 10 to 52 months, with an average of 30. 5 months. 90. 2% of the cases were treated surgically from 2 to 5 （mean, 3.6） days after injury. Reduction evaluation scored 4. 83 points on average. The average bed-ridden time was 3.5 months after surgery. According to Harris scoring for hip function, the result was excellent in 21 cases, good in 15, fair in 3, and bad in 2, with the excellent-to-good rate of 87. 8%. The excellent-to-good rate of Garden type IV is lower than those of Garden types Ⅱ ＆ Ⅲ, and there is no statistical significance. Between them （X^2 = 1.35, P = 0. 25 ） . Conclusions Early surgery, anatomical reduetion, stable fixation with titanium cannulated screws are the key to successful treatment of femoral neck fracture in young adults. Efficient iliac flap grafting, early activities and later weight-bearing can prevent avascular necrosis of femoral head.