不稳定型股骨颈骨折早期闭合复位对骨折预后的影响

Effect of Early Closed Reduction of Unstable Femoral Neck Fracture and Zhenggudan on Fracture Prognosis

目的回顾分析早期闭合复位对不稳定型股骨颈骨折(GardenⅢ、Ⅳ型)预后的影响,为不稳定型股骨颈骨折选择治疗方法提供临床依据。方法回顾性分析2000年1月-2008年12月收治的获得完整回访资料的409例不稳定型股骨颈骨折采取闭合复位空心钉内固定术患者的资料,分为早期闭合复位内固定组(A组)和择期闭合复位内固定组(B组)。其中A组早期行闭合复位内固定,共226例;B组择期行闭合复位内固定,共183例,2组均服用正骨丹作为基础治疗。比较2组骨折不愈合率与股骨头坏死率。结果 A组和B组骨折不愈合率分别为3.98%、4.37%,2组差异无统计学意义;A组和B组股骨头坏死率分别为13.27%、18.58%,2组差异有统计学意义(P<0.05)。且受伤至闭合复位时间越短,股骨头坏死率越低(P<0.05)。结论对不稳定型股骨颈骨折,早期闭合复位可显著降低股骨头坏死率。

OBJECTIVE To review and analyze the effects of early closed reduction of fracture together with Zhenggudan on the prognosis of unstable femoral neck fracture（Garden III and IV style）,and to provide clinical bases for selecting acceptable therapeutic methods.METHODS Retrospectively analyzed the integral medical records of the patients with unstable femoral neck fracture who had been treated by hollow needle internal fixation and had been paid return visits dated from Feb.2000 to Dec.2008,409 cases in total.And then the patients were divided into two groups,the group of early closed reduction of hollow needle internal fixation（Group A） and the group of option forward reduction of hollow needle internal fixation（Group B）.Group A was treated along with Zhenggudan,226 cases in total;Group B was treated along with Zhenggudan,183 cases in total;and then compared the healing rate of fracture and ANFH of the two groups respectively.RESULTS The healing rate of the two groups were separately 3.98% and 4.37%,which was of no statistical significance;the rate of ANSH of the two groups were 13.27% and 18.58%,and the difference had statistical significance（P0.05）.Moreover,the shorter the time was from being wounded to the closed reduction,the less the rate of ANFH would become.CONCLUSION There is no obvious relationship between the nonunion of fracture caused by femoral neck fracture and the occasion of reduction of fracture,which may has relation with Zhenggudan used together in the treatment;but ANFH is closely related with the occasion of reduction of fracture.To the unstable femoral neck fracture,early closed reduction can significantly shorten the union time of fracture,and lower the rate of ANFH.