动力髋螺钉结合植骨治疗延迟处理的不稳定股骨颈囊内骨折的临床疗效

Clinical efficacy of dynamic hip screw combined with internal bone grafting in delayed-processing unstable intracapsular fracture of the femoral neck(IFFN)

目的 评估使用动力髋螺钉(Dynamic Hip Screw,DHS)结合植骨治疗65岁以内延迟治疗的不稳定股骨颈囊内骨折,观察其疗效及不愈合等并发症。方法 选择2012年12月至2017年6月32例移位的股骨颈囊内骨折患者(Garden分型Ⅲ型和Ⅳ型),均未能及时治疗(15~60 d手术),所有患者均采用动力髋螺钉治疗,局部闭合采用铰刀开通通路后闭合下松质骨植骨。结果 骨折平均愈合的时间是3.8个月(3~5个月)。除2例外,其余患者均获得满意愈合。1例发生股骨头缺血性坏死,1例发生髋内翻,有3例患者出现小于10 mm的短缩,无感染或植骨失败。术后功能依据Harris评分,取得了良好的效果,27位患者治疗结果优秀,4位患者的治疗结果为良好,1位患者的治疗结果较差。结论 DHS内固定结合松质骨移植是一种简便有效的方法,该方法可为骨折愈合提供生物学刺激,个别治疗失败的病例可以使用其他治疗办法。

Objective To assess clinical efficacy and complications such as nonunion of dynamic hip screw(DHS)combined with internal bone grafting in delayed-processing unstable intracapsular fracture of the femoral neck(IFFN)in patients younger than 65 years old.Methods Thirty two patients with displaced IFFN(Garden classification:type III and IV)were included in this study from December 2012 to June 2017,who were all not treated in time(15-60 days).All patients were treated with DHS,closed cancellous bone grafting through a tunnel by a reamer.Results The average fracture union time was 3.8 months(3-5 months).Satisfactory fracture union was achieved in 30 patients.There were 1 case of ischemic necrosis of femoral head,1 case of coxa vara,and 3 cases of cripetura(less than 10 mm),without cases of infection or bone grafting failure.The postoperative Harris score showed that excellent results were achieved in 27 patients,good/fair results in 4 patients,and poor result in 1 patient.Conclusion DHS internal fixation combined with cancellous bone grafting is a kind of simple and effective method,which can provide biological stimulation for early bone union.Failure in particular cases can be treated with any appropriate second procedure.