经皮自体骨髓移植加空心螺钉内固定治疗股骨颈骨折的病例对照研究

Case-control study on cannulated screw fixation and percutaneous autogenous bone marrow grafting for the treatment of femoral neck fractures

目的:探讨经皮自体骨髓移植加空心螺钉内固定术治疗股骨颈骨折是否优于单纯空心螺钉内固定术,分析经皮自体骨髓移植加空心螺钉内固定术能否促进股骨颈骨折愈合、减少股骨头坏死。方法:对2000年12月至2008年12月的病例进行回顾性分析:经皮自体骨髓移植加空心螺钉内固定治疗股骨颈骨折30例,其中男20例,女10例;年龄18～89岁,平均(52.3±0.2)岁;车祸伤13例,坠落伤3例,跌倒摔伤14例;GardenⅠ型1例,Ⅱ型6例,Ⅲ型12例,Ⅳ型11例,观察骨折愈合及股骨头坏死情况。对照组30例,男16例,女14例;年龄18～91岁,平均(51.9±0.1)岁;车祸伤12例,坠落伤1例,跌倒摔伤17例;GardenⅠ型5例,Ⅱ型2例,Ⅲ型15例,Ⅳ型8例,只用空心螺钉内固定。对两组的骨折愈合及并发症情况进行随访,随访时间2年。结果:随访2年后观察组与对照组骨折的平均愈合时间分别为(7.1±1.2)、(8.0±1.4)个月。观察组股骨颈骨折愈合29例,坏死1例;对照组股骨颈骨折愈合24例,坏死6例,差异有统计学意义(P<0.05)。结论:经皮自体骨髓移植加空心螺钉内固定可促进股骨颈骨折愈合,减少股骨头坏死等并发症。

Objective：To compare clinical results of two methods for the treatment of femoral neck fracture,which are cannulated screw fixation combined with percutaneous autogenous bone marrow grafting,and simple cannulated screw fixation.To investigate the curative effects of cannulated screw fixation combined with percutaneous autogenous bone marrow garfting to promote fracture healing and reducing femoral neck necrosis.Methods：The clinical data of 60 cases,which were enrolled from December 2000 to December 2008 consecutively in our hospital,were analyzed retrospectively.Thirty patients with femoral neck fractures were treated with cannulated screw fixation and percutaneous autogenous bone marrow grafting.There were 20 males and 10 females,ranging in ages from 18 to 89 years,with an average of （52.3±0.2） years.There were 13 patients with traffic accident,3 patients with falling injuries and 14 patients with tumble.Based on the Garden classification for femoral neck fractures,1 patient was typeⅠ,6 patients were type Ⅱ,12 patients were type Ⅲ and 11 patients were type Ⅳ.Among 30 patients in the control group,16 patients were male and 14 patients were female,ranging in age from 18 to 91 years,with an average of （51.9±0.1） years.Twelve patients injured with traffic accident,1 patient with falling injuries and 17 patients with tumble.Based on the Garden classification for femoral neck fractures,5 patients were typeⅠ,2 patients were type Ⅱ,15 patients were type Ⅲ,and 8 patients were type Ⅳ.Patients in the control group were treated with cannulated screw fixation only.All the patients were followed up for 2 years after operation.The fracture healing and complications were evaluated and compared between the two groups.Results：The average healing time was （7.1±1.2） months in the observing group and （8.0±1.4） months in the control group.The healing of femoral neck fracture occurred in 29 cases in observing group while in 24 cases in the control group contrast to femoral head necrosis occurred in 1 case in the observing group while in 6 cases in the control group.According to Harris scoring system,the good and excellent rate of the two groups had statistical difference （P0.05）.Conclusion：Cannulated screw fixation and percutaneous autogenous bone marrow grafting is a more efficient method for accelerating healing of femoral neck fractures and reducing femoral head necrosis.