改良闭合复位技术治疗股骨颈骨折疗效分析

Analysis of curative effect of traditional Chinese bone setting manipulation for the treatment of femoral neck fracture

目的 :分析改良闭合正骨手法术中复位股骨颈骨折临床疗效。方法 :选择2012年1月至2012年12月收治的股骨颈骨折47例,男25例,女22例;年龄23~61(44.58±10.32)岁。患者均有外伤史,患髋疼痛,活动受限,患肢短缩外旋畸形,X线片示股骨头下至股骨颈基底部之间的骨折,其中GardenⅢ型32例,Ⅳ型15例。入院后2~5 d行手术治疗,术中45°外展和伸直位极度内旋复位,3枚导针呈倒"品"字性结构排列。术后观察复位质量、骨折愈合、股骨头坏死、髋关节功能等。结果:患者手术时间40~70 min,术中出血20~50 ml,所有患者获得良好复位,术中透视12~25次,45例患者随访24~36个月,2例失访;骨折均得到骨性愈合,有3例出现部分股骨头坏死,均处于ARCO分期Ⅱ期。术后24个月,行Harris髋关节评分:疼痛43.24±2.74,功能42.82±1.95,畸形活动3.72±0.45,活动范围2.77±0.52,总分92.56±4.42;结果优39例,良4例,可2例;无断钉、感染、深静脉血栓、再骨折等并发症。结论 :闭合正骨手法术中复位股骨颈骨折效果良好,术后患者髋关节功能恢复好,疗效满意。

Objective：To analysis the outcome of modified closure bone setting manipulation for the treatment of femoral neck fracture. Methods：From January 2012 to December 2012,47 cases of femoral neck fracture were treated and included 25 males and 22 females with an average age of（44.58 ±10.32） years old ranging from 23 to 61 years old. All patients had a history of trauma,hip pain and movement limited,limb shortening extorsion deformity,X-ray showed fracture between femoral head and femoral neck basic. Among them,32 cases were Garden type Ⅲ and 15 cases were type Ⅳ. Patients were performed surgical treatment at 2 to 5 days after admission with 45 degrees abduction and extension position,internal rotation reduction,and 3 guide pins were inverted in a equilateral triangular structure of upside down arrangement. The postoperative recovery quality,fracture healing,femoral head necrosis and hip function were observed. Results：Operation time was 40 to 70 min,intraoperative bleeding was 20 to 50 ml. All patients received good reposition,and the intraoperative perspective was 12 to 25 times. Forty-five patients were followed up for 24 to 36 months,and 2 cases were lost. Fracture of 45 cases were got bony healing,3 cases with partial necrosis of femoral head,both in the ARCO stage Ⅱ. Twenty-four months after operation,Harris hip function score was 43.24±2.74 in pain,42.82±1.95 in function,3.72±0.45 in deformity,2.77±0.52 in activity,92.56±4.42 in total;the outcome was excellent in 39 cases,good in 4 cases,fair in 2 cases,without unbroken nails,infection,deep venous thrombosis,fracture and other complications. Conclusion：Treatment of femoral neck fracture with the modified bone setting manipulation has an advantages of good effect,postoperative hip function recovery,curative effect.