非匀阻变形分叉钉治疗股骨颈骨折155例

Treatment of 155 cases of femoral neck fracture with maldistributed-impedance furcal nail

目的 探讨股骨颈骨折 ,尤其是囊内型股骨颈骨折的治疗方法。 方法 设计新型股骨颈骨折内固定器材非匀阻变形分叉钉 (maldistributed -impedancefurcalnail,MIFnail) (简称“分叉钉”)。自 1982年 2月～ 1997年 12月在两所医院用分叉钉治疗股骨颈骨折 15 5例 ,并与用三翼钉治疗的 137例作比较。该两组中又各自分出开放复位内固定组和闭合复位组 ,共 4组 ,计 2 92例。结果 2 49例获得随访 ,随访时间 18～ 184个月 ,平均 77.6个月。应用SPLM软件包中列联表的对数线型拟合及Ridit统计分析方法 ,分叉开放组与其余 3组之间均有非常显著性差异 (P <0 .0 1) ,开放组与闭合组之间也有显著性差异 (P <0 .0 5 )。 结论 分叉钉与三翼钉比较 ,前者疗效明显高于后者 ;开放复位组与闭合复位组比较 ,前者疗效也明显高于后者 ,而分叉开放组又明显高于其他3组。说明对股骨颈骨折的治疗以采用开放复位和股方肌肌骨瓣植骨术为好。

Objective To explore a treatment of femoral neck fracture, especially intracapsular fracture. Methods A new internal fixation for femoral neck fracture, namely, a kind of maldistributed-impedance furcal nail (MIF nail) was produced. From February 1988 to December 1997, 155 cases of femoral neck fracture were treated with MIF nail and compared with 137 cases treated with tri-flange nail. Each group was subdivided into open reduction group and close reduction group. Altogether there were 4 groups including 292 cases. Results The average duration of follow-up for 249 cases was 77.6 months (18-184 months). SPLM and Ridit statistical software were used to analyze the data. The difference between MIF nail open reduction group and other three groups was significant ( P <0.01). There was significant difference between open reduction group and close reduction group( P <0.05). Conclusions As for curative effect, the furcal nail is better than the tri-flange nail. The comparison between open reduction group and close reduction group proves that the former is better than the latter in treatment. Furthermore, the furcal open reduction group is better than other three groups. All these proves that open reductioin and bone grafting of musculus quadratus femoris are the choices for treatment of femoral neck fracture.