空心加压螺钉治疗股骨颈骨折疗效分析

Analysis of therapeutic effects of cannulated compression screws for the treatment of femoral neck fractures

目的:探讨空心加压螺钉内固定术治疗股骨颈骨折的疗效及术后致股骨头缺血性坏死的相关影响因素。方法:对2003年1月至2009年6月应用空心加压螺钉治疗的96例股骨颈骨折进行回顾性分析,男44例,女52例;年龄21～88岁,平均56.3岁。将患者年龄、性别、骨折类型、骨折复位情况、外伤至手术复位时间与术后骨折不愈合及股骨头缺血性坏死之间的关系进行统计学分析。结果:84例获得随访,时间9～60个月,平均25.4个月。术后出现下肢深静脉血栓2例,骨折不愈合8例,股骨头缺血性坏死11例。术后Harris评分为(86.20±11.00)分,优40例,良32例,可7例,差5例。未移位骨折组和移位骨折组股骨头坏死发生率分别为3.22%和18.87%,两者差异有统计学意义(P=0.037);解剖复位组和非解剖复位组的股骨头坏死发生率分别为5.00%和20.45%,两者差异有统计学意义(P=0.036);而不同年龄、性别、手术时间对继发股骨头坏死无明显差异。结论:空心加压螺钉内固定术治疗无移位股骨颈骨折疗效良好,骨折类型及骨折复位情况是影响术后股骨头缺血性坏死的主要因素。对年轻移位的股骨颈骨折患者,应尽可能解剖复位、牢靠内固定,以减少术后股骨头缺血性坏死的发生;对于骨折移位严重的高龄患者,建议行人工关节置换术。

Objective：To evaluate the therapeutic effects of cannulated compression screws for the treatment of femoral neck fractures,and to investigate the related factors influencing the avascular necrosis of femoral head after surgery.Methods：A retrospective review was done for 96 patients with femoral neck fractures treated with cannulated compression screws from January 2003 to June 2009.Among them,there were 44 males and 52 females with 21 to 88 years old（averaged 56.3 years old）.According to Garden classification,4 patients were typeⅠ,34 patients were typeⅡ,37 patients were type Ⅲ and 21 patients were type Ⅳ.Factors such as patients＇ age,gender,fracture type,duration from injury to surgery and fracture reduction quality were statistically analysed to find correlations with nonunion and avascular necrosis of femoral head.Results：Eighty-four patients were followed up ranging from 9 to 60 months and the mean time was 25.4 months.Postoperative complications included deep venous thrombosis of lower extremity in 2 cases,bone nonunion in 8 cases and avascular necrosis of femoral head in 11 cases.According to Harris criterion,the total postoperative Harris score was 86.20±11.00,and 40 patients got an excellent result,32 good,7 fair and 5 poor.The incidence of avascular necrosis of femoral head in nondisplaced fracture group and displaced fractures group were 3.22% and 18.87% respectively;and there were significant difference between the two groups（P=0.037）.The incidence of avascular necrosis of femoral head in anatomical reduction group and non-anatomical reduction group were 5.00% and 20.45% respectively;also,significant difference was existed between the two groups（P=0.036）.However,there was no statistically significant difference of the incidence of avascular necrosis of femoral head according to different age,sex,operative time.Conclusion：The therapeutic effect of cannulated compression screws for non-displaced femoral neck fractures is good.The fracture type and reduction quality are found to be main factors correlated with avascular necrosis of femoral head statistically.For young patients with a displaced femoral neck fracture,in order to avoid incidence of avascular necrosis of femoral head,anatomical reduction should be ensured.For elder patients with a severe displaced femoral neck fracture,the total hip replacement should be recommended.