改良经皮加压钢板治疗Pauwels Ⅲ型股骨颈骨折的疗效分析

Treatment of Pauwels type Ⅲ femoral neck fractures with modified percutaneous compression plate

目的 :探讨应用改良经皮加压钢板治疗PauwelsⅢ型股骨颈骨折的临床效果。方法 :2012年3月2016年3月对采用闭合复位技术,改良经皮加压钢板手术治疗PauwelsⅢ型股骨颈骨折35例患者进行回顾性分析,男21例,女14例;年龄23~62(45.0±9.1)岁。骨折解剖位置分型:头下型8例,头颈型27例。按照Garden分型:Ⅱ型8例,Ⅲ型18例,Ⅳ型9例。所有患者为闭合性损伤,评价术中复位质量,术后随访观察症状缓解、骨折愈合及并发症发生情况,髋关节功能根据Harris评分进行评价。结果:35例患者均获随访,随访时间15~24个月,平均20个月;所有病例手术切口Ⅰ期愈合。术后无骨折不愈合、股骨头坏死及髋关节内翻畸形。根据Garden对线指数对股骨颈骨折复位质量进行评价,术中复位质量:Ⅰ级复位29例,Ⅰ级复位6例。末次随访髋关节功能Harris评分92.70±4.60,其中优26例,良8例,可1例。均未出现内固定物松动、断钉、及异位骨化等并发症。结论 :改良经皮加压钢板治疗PauwelsⅢ型股骨颈骨折,具有创伤小、操作简单、固定牢靠、功能恢复佳、并发症少等优点。

Objective：To investigate the preliminary effects of modified percutaneous compression plate in treating femoral neck fractures of Pauwels type Ⅲ. Methods：From March 2012 to March 2016,35 patients with femoral neck fracture were treated by closed reduction and internal fixation with a modified percutaneous compression plate,including 21 males and14 females with an average age of 45 years old ranging from 23 to 62 years old. The anatomical position of fracture was divided into 8 cases of lower head type,27 cases of head and neck. According to the Garden classification,there were 8 cases of typeⅡ,18 of type Ⅲ,and 9 of type Ⅳ fractures. All patients were closed injury. The general information,reduction quality,fracture healing time,postoperative complications were recorded and evaluated. Harris scoring was used to evaluate the hip joint function. Results：All patients were followed up for 15 to 24 months with an average of 20 months. All the incisions were primary healing. The reduction quality of the femoral neck fracture was evaluated according to the Garden＇s alignment Index,and the quality of reduction was grade Ⅰ reduction in 29 cases and grade Ⅱ reduction in 6 cases. No nonunion,femoral avascular necrosis,implant failure and hip varus was observed during follow-up. Harris score was（92.70±4.60） points at final follow-up,the results of the treatment was evaluated as excellent in 26 cases,good in 8 cases,fair in 1 case. No complications such as internal fixation loosening,nail breaking,and heterotopic ossification occurred. Conclusion：Internal fixation with modified percutaneous compression plate has an advantages of decreased trauma,simple operation,rigid fixation,good function outcome,and low risk of complications.