侧方入针股骨头干三维互动技术治疗成人难复位性股骨颈骨折

Three dimensional interactive reduction of femoral head-shaft plus lateral needling for irreducible femoral neck fractures

目的探讨侧方入针股骨头干三维互动闭合复位技术治疗成人难复位性股骨颈骨折的疗效。方法2009年1月至2010年12月共收治10例成年难复位性股骨颈骨折患者，男6例，女4例；年龄22—60岁，平均40．5岁；骨折Garden分型均为Ⅳ型。所有患者均采用侧方入针股骨头干三维互动闭合复位技术3枚空心加压螺钉内固定术治疗。记录患者的手术时间、术中出血量和复位质量，末次随访时根据髋关节Harris评分标准评定疗效。结果本组患者平均手术时间为51min（30～65min），平均术中出血量为37mL（20～50mL）。10例患者术后获平均3．0年（1．5～4．2年）随访。9例患者骨折复位质量达Garden指数Ⅰ级，1例达Garden指数Ⅱ级。所有患者骨折均获骨性愈合，愈合时间为15～21周，平均18．1周。1例患者于术后2年发生股骨头坏死，采用全髋关节置换术治疗。末次随访时根据髋关节Harris评分标准评定疗效：优8例，良1例，可1例。结论侧方入针股骨头干三维互动闭合复位技术治疗成人难复位性股骨颈骨折具有创伤小、操作简单、容易掌握及复位效果理想等优点，尤其适用于较肥胖、不易触及股动脉搏动的患者。

Objective To evaluate the efficacy of three dimensional （3D） interactive reduction of femoral head-shaft plus lateral needling for irreducible femoral neck fractures. Methods From January2009 to December 2010, 10 adult patients suffering from irreducible femoral neck fracture were treated in our department. They were 6 men and 4 women, from 22 to 60 years of age （average, 40.5 years） . All thefractures were of Garden type Ⅳ. They were all treated with 3D interactive reduction of femoral head-shaft plus lateral needling followed by internal fixation with 3 cannulated compression screws. Their operative time,intraoperative blood loss and quality of reduction were recorded and their functional recovery was evaluated at the last follow-up according to the Harris scoring system. Results In this group, the operative time averaged 51 minutes （from 30 to 65 minutes） and the intraoperative blood loss 37 mL （from 20 to 50 mL）. They were followed up for an average of 3.0 years （from 1.5 to 4.2 years） . Nine cases obtained reduction ofGarden Grade I and one Garden Grade Ⅱ. Bony union was achieved in all patients after 15 to 21 weeks （average, 18.1 weeks）. One patient who had developed necrosis of femoral head 2 years postoperation had toundergo total hip replacement. By the Harris Hip Score, 8 were excellent, one good and one fair. Conclusion In treatment of adult patients with irreducible femoral neck fracture, the 3D interactive reduction offemoral head-shaft plus lateral needling, which is minimally invasive and simple, can achieve satisfactory anatomic reduction, especially in obese ones whose femoral pulse is hard to palpate.