髋前侧小切口植骨及内固定治疗中老年股骨颈骨折

Autogenous Iliac Bone Graft through an Anterior Small Incision Combined with Internal Fixation for Displaced Femoral Neck Fractures in Middle-aged and Elderly Patients

目的探讨髋前侧小切口自体髂骨植骨及空心钉内固定治疗中老年移位型股骨颈骨折的疗效是否优于单纯空心钉内固定术。方法回顾分析2006年1月～2011年5月在我院治疗并获得随访的49例中老年移位型股骨颈骨折的临床资料,其中26例行单纯空心钉内固定术(对照组),23例行髋前侧小切口自体髂骨植骨及空心钉内固定术(植骨组),比较2组围术期情况和疗效。结果与对照组相比,植骨组手术时间长[(53.5±12.7)min vs.(40.4±9.7)min,t=4.084,P=0.000],术中出血量多[(66.1±22.7)ml vs.(46.4±13.8)ml,t=-3.719,P=0.000],术后住院时间无统计学差异[(7.1±2.9)d vs.(6.2±3.6)d,t=-0.955,P=0.344],但术后骨折愈合率高[100.0%(23/23)vs.76.9%(20/26),P=0.016],股骨头缺血性坏死率低[8.7%(2/23)vs.34.6%(9/26),χ2=4.710,P=0.030]。49例随访12～48个月,平均25个月。根据髋关节功能Harris评分标准,植骨组术后评分显著高于对照组[(85.7±4.3)分vs.(79.1±6.2)分,t=-4.274,P=0.000]。结论髋前侧小切口自体髂骨植骨及空心钉内固定治疗中老年移位型股骨颈骨折,骨折愈合率高,股骨头缺血性坏死率较低,对中老年股骨颈骨折治疗具有积极意义。

Objective To compare the results of cannulated screw fixation plus autogenous iliac bone graft through an anterior small incision and cannulated screw fixation alone for displaced femoral neck fractures in middle-aged and elderly patients. Methods We reviewed the clinical data of 49 middle-aged or elderly patients with displaced femoral neck fractures, who received simple cannulated screw fixation （control group, n = 26） or cannulated screw fixation combined with autogenous iliac bone graft thrdugh an anterior small incision （bone graft group, n =23） in our hospital, from January 2006 to May 2011. The outcomes of the two groups were compared. Results Bone graft group showed significantly longer operation time, more intraoperative blood loss, higher rate of postoperative bone reunion, lower rate of femoral head avascular necrosis, but similar postoperative hospital stay than the control （53.5±12.7）min vs. （40.4＋9.7） min, t=4.084, P=0. 000; （66.1±22.7） mlvs. （46.4±13.8） ml, t= -3.719, P= 0.000; 100.0% （23/23） vs. 76.9% （20/26）, P=0.016; 8.7% （2/23） vs. 34.6% （9/26）,X2 =4.710, P=0.030 ; and （7. 1±2.9） d vs. （6.2＋3.6） d, t= -0.955, P=0.344; respectively]. The patients were followed up for 12 to 48 months with a mean of 25 months, during which the bone graft group showed significantly higher Harris score than the control （85.7 ± 4.3 vs. 79.1 ± 6.2, t = - 4. 274, P = 0. 000）. Conclusion Autologous iliae bone graft through an anterior small incision combined with eannulated screw fixation is an effective way for the management of displaced femoral neck fractures in middle-aged and elderly patients, considering its high rate of fracture union and low rate of avascular necrosis of the femoral head.