闭合复位动力髋螺钉联合防旋螺钉内固定治疗Pauwels Ⅲ型股骨颈骨折

Closed reduction with dynamic hip screw and anti-rotation screw for patients with Pauwels type Ⅲ femoral neck fracture

目的探讨应用股骨头干三维互动闭合复位动力髋螺钉（dynamichipscrew，DHS）加防旋螺钉内固定治疗PauwelsⅢ型股骨颈骨折的临床疗效。方法应用DHS联合防旋螺钉内固定治疗PauwelsⅢ型股骨颈骨折19例。骨折解剖位置分型：头下型14例，头颈型5例；按Garden分型：Ⅲ型7例，Ⅳ型12例，其中伴有股骨头旋转2例。所有骨折均采用股骨头干三维互动闭合复位技术复位，复位满意后应用DHS联合1枚防旋螺钉内固定。结果利用Garden对线指数对股骨颈骨折复位进行评价，Ⅰ级复位16例（84．2％），Ⅱ级复位3例（15．8％）。手术时间50～65min，平均（52．2±2．4）min，出血量40—80ml，平均（48．7±3．2）ml。所有患者术后均获随访，随访时间13～25个月（平均18．5个月），骨折全部愈合，无一例发生股骨头缺血性坏死及髋内翻等并发症。Harris髋关节评分为89—100分。结论股骨头干三维互动闭合复位DHS加防旋螺钉内固定治疗Pauwelsm型股骨颈骨折，并发症少，成功率高。

Objective To evaluate the therapeutic efficacy of closed reduction technique with dynamic hip screw and anti-rotation screw in treating patients with Pauwels type Ⅲ femoral neck fracture. Methods From Jan. 2010 to Nov. 2011,19 cases of Pauwels type Ⅲ femoral neck fractures were admitted into our centre. According to the Delbet classification ,there were 14 cases of subcapital fractures and 5 cases of transcervical fractures. Mean- while,referring to the Garden classification,there were 7 cases of type m and 12 cases of type Ⅳ. Two cases were associated with femoral head rotation. All cases were treated by closed reduction teehnique , and then fixed with dy- namic hip screw and anti - rotation screw. Results In terms of the curative efficacy, 16 of all patients （ 84. 2% ） achieved an anatomical reduction,while 3 cases achieved an acceptable reduction（15.8%）. The operation time ranged from 50 minutes to 65 minutes （ averaging 52. 2 ± 2. 4 minutes）. The blood loss during surgery ranged from 40 to 80 ml（ averaging 48.7 ± 3.2 ） ml. The patients were followed up for 13-25 months with an average of 18.5 months. All fractures healed without complications such as femoral head avascular necrosis. The Harris hip joint score ranged from 89 to 100. Conclusion The closed reduction technique with dynamic hip screw and anti-rotation screw for treating Pauwels type m femoral neck fracture has the advantages of less complications and high success rate.