前侧小切口切开复位内固定治疗股骨颈骨折的临床研究

The clinical research of displaced femoral neck fracture treated by anterior incision

目的探讨前侧小切口切开复位内固定治疗移位型股骨颈骨折的效果。方法2005至2007年间,本组共收治疗65岁以下股骨颈骨折的患者179例,笔者对其中因闭合复位失败,行前侧小切口切开复位,加外侧小切口置入内固定空心钉并获随访的22例股骨颈骨折患者进行回顾性分析,其中男9例,女13例,年龄21～58岁。受伤原因为高处跌落、摔伤或交通事故,手术时间为伤后2～14d;骨折分型:GardenⅢ型15例,GardenⅣ型7例,其中经颈型17例,头下型5例。平均随访20个月。结果22例患者中复位优良者7例,复位良好者15例。出现股骨头坏死有5例(22.7%),未发现骨不连患者,骨折愈合且未出现股骨头坏死者17例(77.2%)。5例股骨头坏死的患者中,仅3例有轻度疼痛或无明显疼痛而不需要行关节置换,均建议行体外震波治疗,另外2例股骨头坏死塌陷明显,建议行全髋关节置换手术,其中1例为股骨颈粉碎性骨折。结论虽然前侧小切口切开复位内固定治疗移位型股骨颈骨折,未能减少股骨头坏死的发生率,但由于其与传统的切口相比,仍然具有手术创伤小、时间短、术中出血少及术后康复快等优点。

Objective To study the results of open reduction and internal fixation treated the displaced femoral neck fracture by anterior incision. Methods Between 2005 and 2007, twenty-two displaced femoral neck fractures were analyzed retrospectively in 22 consecutive patients （ male 9 cases, female 13 cases, ranging in age from 21 to 58 years）, who were treated with opened reduction and internal fixation （ORIF） by anterior incision in our hospital. The femoral neck fracture resulted from a motor vehicle collision or a fall from a standing position or falling from the high. The operations were performed between 2 and 14 days after injury. The mean duration of follow-up was 1.6 years. All cases were followed up for average 1. 6 years. The results and complications of treatment were retrospectively reviewed. Results The position of all fractures after reduction and fixation were excellent or good. 17 of the 22 fractures （77. 2% ） healed after one operation and were associated with no evidence of osteonecrosis of the femoral head. Osteonecrosis developed in association with 5 （22. 7% ） fractures. Of 5 osteonecrosis of the femoral head, 3 cases （ Ficat Ⅰ,Ⅱ） were suggested to take the extracoporeal shock wave treating the osteonecrois, and 2 cases （Ficat Ⅲ,Ⅳ ） were suggested to take THA. Conclusions The displaced femoral neck fractueres treated by the anterior incision does not lower the incidence of the osteonecrosis of femoral head and nonunion, but the anterior incision can obviously decrease the surgical trauma, surgical time, surgical bleed. However, the anterior incision posses the advantage of less trauma, less perioperative bleeding and rapid recovery.