空心钉与髓内钉治疗青壮年股骨颈不稳定骨折的疗效观察

Comparison between directed anterior appoach assisted cannulated screw and intramedullary fixation for young adults with unstable femoral neck fractures

目的分析在直接前侧入路(DAA)辅助下空心螺钉与Intertan髓内固定治疗青壮年移位不稳型股骨颈骨折的临床疗效。方法回顾分析浙江新安国际医院骨科2014年1月至2016年12月采用DAA入路切开复位治疗青壮年移位不稳定型(GardenⅢ、Ⅳ型)股骨颈骨折患者,资料均为GardenⅢ、Ⅳ不稳定型股骨颈骨折,24 h之内完成手术,年龄<60岁且随访资料完整;排除同侧转子间骨折、转子下骨折、股骨干骨折,长期使用大剂量激素或酗酒患者。DAA辅助空心钉螺钉内固定组(空心钉组) 90例,DAA辅助Intertan髓内钉固定组(髓内钉组) 89例,采用SPSS 21. 0统计学软件对数据进行统计学分析。采取t检验和X^2检验比较手术时间、透视次数、出血量、住院日、骨折愈合时间、骨折不愈合及股骨头缺血性坏死率、Harris评分。结果两组在年龄、性别、Garden分型比较上,差异无统计学意义(均P> 0. 05),有可比性。空心钉组在手术时间(45. 4±15. 6) min、透视次数(6. 5±3. 4)次、出血量(90. 5±24. 5) ml方面优于髓内钉组[分别为(75. 2±12. 4) min,(9. 3±4. 6)次,(159. 7±40. 2) ml](均为P <0. 01);空心钉组在住院日(7. 2±2. 1) d方面与髓内钉组(8. 2±1. 3) d没有差异(t=-1. 567,P> 0. 05)。髓内钉组愈合时间(2. 8±0. 8)月,短于空心钉组[(3. 8±0. 7)月,(t=5. 375,P <0. 01)]。髓内钉组骨折不愈合、股骨头缺血性坏死4例明显少于空心钉组15例(X^2=6. 005,P <0. 05); Harris评分优良率空心钉组低于髓内钉组(X^2=7. 338,P <0. 01)。结论青壮年移位不稳定型股骨颈骨折早期采用DAA辅助入路Intertan髓内固定方法治疗可在直视下完成骨折复位,术后恢复快,骨折愈合率高,股骨头坏死发生率低,疗效满意。

Objective To analyze the clinical efficacy of direct anterior approach(DAA)-assisted cannulated screw and Intertan intramedullary fixation in the treatment of unstable femoral neck fractures in young adults.Methods From January 2014 to December 2016,179 cases of displaced unstable(Garden Ⅲ or Ⅳ)femoral neck fractures in young adults were treated by open reduction of direct anterior approach(DAA).Inclusion creteria:surgery is completed within 24 hours,age<60 years old and follow-up data intact;exclusion creteria:ipsilateral intertrochanteric fractures,subtrochanteric fractures,femoral shaft fractures,long-term use of large doses of hormones or alcohol abuse patients.Ninety cases were treated by DAA-assisted cannulated screw fixation in group A and 89 cases were treated by DAA-assisted Intertan intramedullary fixation in group B.Data were statistically analyzed using SPSS 21.0 statistical software with t test and 2 test to compare the operation time,the number of fluoroscopy,the amount of bleeding,the hospitalization day,the fracture healing time,the fracture nonunion,the avascular necrosis rate of the femoral head,and the Harris score.Results There was no significant difference in age,gender,and Garden classification between the two groups(all P>0.05),which was comparable.Group A was superior to group B in terms of operation time[group A(35.4±15.6)min,group B(55.2±12.4)min],number of X-ray exminations[group A(6.5±3.4)times,group B(9.3±4.6)times],and bleeding volume[group A(70.5±24.5)ml,group B(129.7±40.2)ml](all P<0.01).Group A did not differ from group B in hospitalization day[(7.2±2.1)d vs.(8.2±1.3)d,t=-1.567,P>0.05].The healing time of group B(2.8±0.8)months was shorter than that of group A(3.8±0.7)months(t=5.375,P<0.01).In group B,nonunion and avascular necrosis of the femoral head occurred in four cases,which were significantly less than those in group A(15 cases)(χ^2=6.005,P<0.05).In group B,three cases were poor in Harris score,which were less than group A(15 cases were poor)(χ^2=7.338,P<0.01).Conclusion Young adults with unstable femoral neck fracture treated with DAA-assisted Intertan intramedullary fixation can achieve completely reduction of bone under direct vision,with fast postoperative recovery,high healing rate,and low incidence of femoral head necrosis;the effect is satisfactory.