改良撬拨闭合复位内固定修复复杂股骨颈骨折及内固定植入物的选择

Modified poking closed reduction for complex femoral neck fractures and choice of implant

背景:股骨颈骨折后常用闭合复位内固定进行手术治疗,但仍有一部分患者常规手法闭合复位失败。目的:观察复杂股骨颈骨折运用改良撬拨闭合复位内固定的临床疗效。方法:收集2011年12月至2013年10月期间上海交通大学附属第六人民医院骨科复杂股骨颈骨折住院患者36例,经过常规手法复位失败一两次后,采用改良的撬拨闭合复位空心加压螺钉内固定。根据年龄、骨折类型、骨密度状况选择动力髋螺钉加1枚空心螺钉(n=17)或3枚空心螺钉(n=19)内固定。内固定后随访采用Harris评分评价临床疗效。结果与结论:所有36例患者均得到随访,随访时间6个月-2年,平均15.5个月。发生股骨头坏死患者3例,骨折延迟愈合2例。Garden复位质量评价:Ⅰ级23例,Ⅱ级11例,Ⅲ级2例,Ⅳ级0例,Ⅰ级、Ⅱ级占患者总数的94.4%。Harris评分情况:优22例,良7例,中3例,差4例,优良率80.56%。且采用动力髋螺钉加空心螺钉或3枚空心螺钉进行内固定的患者的髋关节Harris评分接近(P>0.05)。因此,对于常规复位失败的复杂股骨颈骨折,建议尝试改良的撬拨闭合复位法,内固定采用动力髋螺钉或空心螺钉对疗效无明显影响。

BACKGROUND：Femoral neck fracture was generaly treated with closed reduction and internal fixation, but there are stil some patients failing to get wel with the conventional technique of closed reduction. OBJECTIVE：To observe clinical therapeutic effects of modified poking closed reduction technique for complex femoral neck fractures. METHODS： A total of 36 cases of complex femoral neck fracture were colected from the Department of Orthopedics, Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University in China from December 2011 to October 2013. After one or two failures of conventional technique for closed reduction, they were treated with modified poking closed reduction and holow screw fixation. According to age, type of fracture and bone density, dynamic hip screw combined with one holow screw （n=17） or three holow screws （n=19） were used. After fixation, clinical efficacy was evaluated with the Harris Hip Score during folow-up. RESULTS AND CONCLUSION：Al 36 patients were folowed up for 6 months to 2 years, with an average of 15.5 months. Osteonecrosis appeared in three cases and delayed fracture healing happened in two cases. Garden reset quality evaluation results were as folows： grade I in 23 cases, grade II in 11 cases, grade III in 2 cases, grade IV in 0 case; grade I and grade II accounted for 94.4% of the total number of patients. Harris Hip Score results were as folows： excelent in 22 cases, good in 7 cases, average in 3 cases, and poor in 4 cases, with an excelent and good rate of 80.56%. Harris scores were similar between patients receiving dynamic hip screw and one holow screw or three holow screws （P〉 0.05）. Therefore, our suggestion is that the patients with complex femoral neck fractures may try to be treated with modified poking closed reduction technique when conventional reduction technique failed. Dynamic hip screw or holow screw did not obviously affect therapeutic outcomes.