中西医结合疗法预防股骨颈骨折股骨头坏死的研究

Study on therapy of Chinese and western medicine for prevention for femoral head necrosis after thighbone neck bone fracture

目的探讨中西医结合疗法预防股骨颈骨折股骨头坏死的效果,以便有效地解决股骨颈骨折股骨头坏死率高的问题。方法选取股骨颈骨折GardenⅢ型患者39例和GardenⅣ型患者29例,均于入院72 h内尽早行微创经关节囊穿针引导复位空心钉内固定术。术后第1天开始每日2次口服壮骨活血方,共用12周。分别于术后、1个月、3个月、6个月、12个月、24个月,拍摄股骨颈正侧位X线片,观察骨折复位、愈合情况及股骨头坏死发生情况,并于伤后3个月、6个月、12个月查双髋关节MRI,观察有无患侧股骨头坏死情况。结果本组65例患者于术后4~6个月骨折临床愈合,3例（4%）骨折不愈合,4例（6%）发生股骨头坏死。结论在股骨颈骨折治疗中,尽早实施微创经关节囊穿针引导复位空心钉内固定术并于术后口服自拟壮骨活血方可促进骨折愈合,缩短骨折愈合时间,降低股骨头坏死发生率。

Objective It is to explore the effect of Chinese and Western medicine therapy on prevention for femoral head necrosis after thighbone neck fractures resolve the problem of thighbone neck fractures with high rate of osteonecrosis.Methods 39 cases of patients with femoral neck fracture of Garden Ⅲ type and 29 cases of ones of Garden Ⅳ type were chosen and were accepted minimally invasive joint capsule pin boot cannulated screws fixation as early as possible within 72 h after hospitalization.Zhuangguhuoxue decoction was used by oral use twice a day from the first day after operation and for 12 weeks.Respectively after 1 month,3 months,6 months,12 months,24 months,X-ray pictures of thighbone neck at direct and latus position were shot to observe reduction and healing and occurrence of femoral head avascular necrosis,and in 3 months,6 months,12 months MRI examination of both hip joints were done to observe whether any avascular necrosis existed.Results 65 patients in this group had clinical healing of fracture in 4-6 months after operation,and 3 patients＇ fracture was not healing.There were 4 patients with avascular necrosis of femoral head.Conclusion Treatment for thighbone neck fractures with minimally invasive joint capsule pin boot cannulated screws fixation as early as possible combined with Zhuangguhuoxue decoction can promote fracture healing,shorten fracture healing time and low down the occurring rate of femoral head.