股骨颈骨折闭合复位的实际效果分析

Analysis of close reduction under the C-arm X-ray perspective for femoral neck fractures

目的 探讨股骨颈骨折闭合复位在C型臂X线机下达解剖复位时骨折端的实际移位情况.方法 自2006年6月至2009年6月对12例股骨颈骨折患者行切开复位内固定,其中男8例,女4例;年龄23～65岁,平均42.3岁.骨折按Garden分型：Ⅲ型7例,Ⅳ型5例.切开前先尝试行牵引闭合复位,C型臂X线机透视满意后,对骨折端进行临时固定,之后切开关节囊对骨折端进行观察,比较闭合复位后C型臂X线机所显示的骨折移位距离与切开后直视下测得的骨折移位距离,同时调整复位并置入内固定.结果 12例患者行闭合复位后用C型臂X线机透视观察,其中7例基本达到解剖复位,但切开前关节囊观察,发现均仍存在不同程度的移位.另外5例在C型臂X线机透视下有难以纠正的轻度移位存在,切开前关节囊观察后,发现其折端的实际移位距离也均大于C型臂X线机所示.12例患者折端实际在前后方向上平均多移位（3.21±0.96）mm,差异有统计学意义（t=11.540,P=0.000）;在上下方向上平均多移位（0.58±0.93）mm,差异无统计学意义（t=2.184,P=0.346）.结论 股骨颈骨折闭合复位难以达到准确的解剖复位,骨折端实际移位距离大于复位后C型臂X线机上所显示的距离.对于股骨颈骨折的治疗,切开复位比闭合复位更具优势.

Objective To evaluate the actual displacement of a femoral neck fracture following close reduction under the C-arm X-ray perspective.Methods From June, 2006 to June, 2009, we managed 12 patients with femoral neck fracture by open reduction and internal fixation.They were 8 males and 4 females, aged from 23 to 65 （average, 42.3） years old.We tried close reduction of their fractures under the C-arm X-ray perspective before a temporary fixation.Next we performed open reduction, readjusted the fracture ends, and placed internal fixation.The actual displacement of the fracture measured after open reduction was carefully compared with the close reduction under the X-ray perspective.Results A substantial displacement was found after open reduction in 7 patients who had achieved anatomic reduction under the X-ray perspective.In the other 5 patients who presented with a slight displacement after close reduction under X-ray perspective, the actual displacements were larger than the X-ray observations but completely reduced after open reduction.The actual measurements after open reduction were significantly larger （3.21 ± 0.96 mm on average） in the anteroposterior displacement （ t = 11.540, P = 0.000）, but insignificantly larger （0.58 ±0.93 mm on average） in the superior-inferior displacement （ t = 2.184, P = 0.346） than those after close reduction.Conclusions In general, anatomic reduction can not be achieved for a femoral neck fracture under the C-arm X-ray perspective.Consequently, open reduction may be better than close reduction in the treatment of femoral neck fracture in that improper reduction can block blood supply to the femoral neck and dissection of the capsula articularis coxae can improve blood supply as well as help decompression.