经颈囊内减压空心钉内固定治疗低龄老年股骨颈GardenⅢ型骨折

Intra-articular decompression through femoral neck and internal fixation with cannulated screws for treatment of GardenⅢ femoral neck fracture in younger aged patients

[目的]以影响股骨颈骨折预后的可控性和可干预性相关因素为治疗导向,探讨对老年股骨颈GardenⅢ型骨折采用闭合手法复位空心钉内固定经颈囊内减压术治疗的临床疗效。[方法]将2005年9月~2010年9月在本院接受闭合手法复位空心钉内固定术治疗的251例老年股骨颈GardenⅢ型骨折患者纳入研究,按是否行经颈囊内减压术分为减压组和常规组。对两组患者的临床资料进行回顾性对照分析,比较两组骨折愈合率、愈合时间、股骨头坏死率和末次随访时髋关节功能评分。[结果]均获60~120个月随访,平均68.2个月。切口均一期愈合,无感染。减压组骨折愈合率95.1%、骨折平均愈合时间(8.3±2.1)个月、股骨头坏死率7.7%、髋关节功能Harris评分(90.6±6.5)分。常规组分别为92.7%、(12.7±3.3)个月、16.5%和(78.3±9.2)分。两组股骨头坏死率、骨折愈合时间及疗效比较,差别有统计学意义(P<0.05)。[结论]经颈囊内减压术操作简单、安全,其与老年GardenⅢ型股骨颈骨折内固定术后骨折愈合时间的缩短及股骨头坏死率的降低可能相关。以影响股骨颈骨折预后因素为导向,有效控制可控性因素、正性干预不可控性因素,低龄老年GardenⅢ型新鲜股骨颈骨折可首选闭合复位加压空心钉内固定经颈囊内减压术治疗。

[Objective] To investigate the clinical effect of closed reduction, internal fixation with cannulated screws, and intra-articular decompression through the femoral neck for the treatment of younger aged patients with Garden Ⅲ femoral neck fracture. [Methods] A retrospective analysis was performed on the clinical data of 251 elderly patients with Garden Ⅲ femoral neck fracture who underwent closed reduction and internal fixation with cannulated screws in our hospital from September 2005 to September 2010. They were divided into decompression group and conventional group according to whether they underwent intra-articular decompression through femoral neck. The two groups were compared in terms of fracture union rate, fracture healing time, femoral head necrosis rate, and Harris hip score at the last follow-up. [Results] All patients were followed up for 68.2 months （60- 120 months） . Primary healing of all incisions was achieved and no infection＂ was observed. There were significant differences in mean fracture healing time （8.3＋2.1 months vs 12.7±3.3 months, P 〈0.05） , femoral head necrosis rate （7.7% vs 16.5%, P 〈0.05） , and Harris hip score （90.6＋6.5 vs 78.3＋9.2, P 〈0.05） between the decompression group and the conventional group. However, there was no significant difference in fracture healing rate between the decompression group and the conventional group （95.1% vs 92.7%, P 〉0.05） . [Conclusions] Intra-articular decompression through the femoral neck is simple and safe and it can accelerate fracture healing and reduce femoral head necrosis rate for younger aged patients with Garden Ⅲ femoral neck fracture after internal fixation. Closed reduction, internal fixation with cannulated screws, and intra-articular decompression through the femoral neck can be the first choice for the treatment of younger aged patients with Garden Ⅲ femoral neck fracture.