Gotfried阳性支撑复位结合空心螺钉内固定治疗中青年股骨颈骨折的近期疗效

Short-term effectiveness of the Gotfried positive buttress reduction plus fixation with cannulated screws for femoral neck fracture in young and middle-aged people

目的探讨Gofffied阳性支撑复位结合空心螺钉内固定治疗中青年股骨颈骨折的近期疗效。方法回顾性分析2009年9月至2014年9月期间采用闭合复位空心螺钉内固定治疗的117例65岁以下股骨颈骨折患者资料，根据患者骨折复位质量不同分为3组：A组（解剖复位组）40例，男29例，女11例；平均年龄为（49．5±11．4）岁。B组（Gotffied阳性支撑复位组）39例，男25例，女14例；平均年龄为（47．6±11．7）岁。c组（Gotfried阴性支撑复位组）38例，男30例，女8例；平均年龄为（48．7±11．8）岁。比较3组患者术后1年颈短缩的发生情况，以及末次随访时骨折不愈合、股骨头缺血性坏死的发生率、髋关节Harris评分等。结果末次随访时A组、B组、C组患者术后股骨头缺血性坏死的发生率分别为15．0％、15．4％、18．4％，3组比较差异无统计学意义（P〉0．05）。术后1年A组、B组患者术后Ⅱ度颈短缩的发生率（7．5％、7．7％）显著低于C组患者（26．3％），差异均有统计学意义（P〈0．05）。末次随访时A组、B组患者髋关节Harris评分[（84．5±6．8）、（86．0±6．6）分]显著高于C组患者[（78．9±7．8）分]，差异有统计学意义（P〈0．05）。结论Gotfried阳性支撑复位结合空心螺钉内固定在预防中青年股骨颈骨折术后严重颈短缩及改善髋关节功能方面与解剖复位效果相似，显著优于Gotfried阴性支撑复位。对于难复位性股骨颈骨折，若已实现Gotffied阳性支撑，可不必追求解剖复位，但Gofffied阴性支撑复位应尽量避免。

Objective To evaluate the short-term effectiveness of Gotfried positive buttress reduction plus fixation with cannulated screws （CSs） for young and middle-aged patients with femoral neck fracture. Methods A retrospective analysis was made of the clinical data of 117 patients under 65 years old with femoral neck fracture who had been fixated by CSs between September 2009 and September 2014. They were divided into 3 groups according to the first postoperative anteroposterior view of hip X-ray： anatomic reduction （group A）, Gotfried positive buttress reduction （group B）, and Gotfried negative buttress reduction （group C）. There were 29 men and 11 women with a mean age of 49.5 ± 11.4 years in group A, 25 men and 14 women with a mean age of 47.6 ± 11.7 years in group B, and 30 men and 8 women with a mean age of 48.7 ± 11.8 years in group C. There was no significant difference in general preoperative demographics （ P 〉 0. 05）. The 3 groups were compared in terms of femoral neck shortening one year postoperatively, fracture ununion, femoral head necrosis and Harris hip score at the final follow-ups. Results The incidences of femoral head necrosis in groups A, B and C were 15.0%, 15.4% and 18.4%, respectively, showing no significant difference between groups （ P 〉 0. 05）. The incidences of degree II femoral neck shortening for groups A and B （7.5% and 7.7% ） were significantly lower than that for group C （26. 3% ） （ P 〈 0.05）. The mean Harris hip scores at the final follow-up for groups A and B （84. 5 ±6.8 and 86. 0 ±6. 6） were significantly higher than that for group C （78.9 ± 7.8） （ P 〈 0. 05）. Conclusions Gotfried positive buttress reduction plus fixation with cannulated screws for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better ones than Gotfried negative buttress reduction. As a result, there is no need to pursue forcefully anatomic reduction in patients with irreducible femoral neck fracture when Gotfried positive buttress reduction has been achieved, but the negative status should be avoided.