摘要
目的探讨术前牵引对股骨颈骨折术后发生股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的影响。方法以2013年2月-2016年5月行空心螺钉固定的股骨颈骨折患者作为研究对象,其中120例符合选择标准纳入研究。60例GardenⅠ、Ⅱ型患者为骨折无移位组,60例GardenⅢ、Ⅳ型为骨折移位组;两组患者均随机分为牵引、非牵引亚组,各亚组30例。骨折移位及无移位组中,两亚组患者性别、年龄、致伤原因、损伤侧别、受伤至手术时间以及骨折分型比较,差异均无统计学意义(P>0.05),具有可比性。术前记录患髋关节囊内压;术中复位固定后,评价骨折复位质量及螺钉植入满意率;术后6个月、1年、2年记录疼痛视觉模拟评分(VAS)、关节功能Harris评分、关节活动度,以及ONFH发生情况。结果两组术后切口均Ⅰ期愈合,无感染及下肢深静脉血栓形成等并发症发生。患者均获随访2年。骨折无移位及移位组中,牵引亚组囊内压均高于非牵引亚组(P<0.05);骨折复位质量及螺钉植入满意率比较,差异均无统计学意义(P>0.05)。术后6个月、1年及2年,牵引亚组患髋VAS评分高于非牵引亚组,关节活动度、Harris评分低于非牵引亚组,差异均有统计学意义(P<0.05)。X线片复查示骨折均愈合,除骨折无移位组术后6个月无ONFH发生外,其余时间点两组中牵引亚组ONFH发生率均高于非牵引亚组(P<0.05)。结论术前牵引可能增加ONFH发生风险,其作用机制之一可能是牵引增加髋关节囊内压,影响股骨头血供。
Objective To explore the impact of preoperative traction on the osteonecrosis of the femoral head(ONFH) in patients with femoral neck fractures. Methods Between February 2013 and May 2016, 120 patients with femoral neck fractures, who were treated with screw fixation, were collected. Sixty patients with fractures of Garden typeⅠ and Ⅱ were non-displaced fracture group;60 cases with fractures of Garden type Ⅲ and Ⅳ were displaced fracture group. The patients in 2 groups were randomly divided into traction and non-traction subgroups(n=30). There was no significant difference in gender, age, injury mechanism, damage side, the time from injury to operation, and fracture classification between 2 subgroups(P>0.05). Intracapsular pressure was recorded before operation. The quality of fracture reduction and the satisfaction ratio of screw implant were evaluated during operation. Visual analogue scale(VAS), Harris score, joint mobility, and the incidence of ONFH would be evaluated at 6 months, 1 year, and 2 years after operation.Results All incisions of 2 groups healed by first intention after operation. There was no infection or deep vein thrombosis of lower extremity. All patients were followed up 2 years. In displaced and non-displaced fracture groups,the intracapsular pressure of traction subgroups were higher than that of non-traction group(P<0.05);the differences of the quality of fracture reduction and the satisfaction ratio of screw implant were not significant(P>0.05) between2 subgroups. At 6 months, 1 year, and 2 years after operation, VAS scores were higher in traction subgroup than in nontraction subgroup(P<0.05);and the joint mobility and Harris scores were lower in traction subgroup than in non-traction subgroup(P<0.05). X-ray films showed all fractures healed. Except for the non-displaced group at 6 months, the incidences of ONFH were higher in traction subgroup than in non-traction subgroup at other time points(P< 0.05).Conclusion Preoperative traction may increase the risk of ONFH, which can increase the intracapsular pressure and affect the blood supply of femoral head.
作者
李海波
许圣茜
汤雪霞
王娜
徐琳
王跃
卢冰
苟永胜
LIH aibo;XU Shengxi;TANG Xuexia;WANG Na;XU Lin;WANG Yue;LU Bing;GOU Yongsheng(Department of Orthopaedics,the First People's Hospital ofShuangliu District,Chengdu Sichuan,610200,P.R.China;Department of Orthopaedics,Sichuan Academy of Medical Science&Sichuan Provincial People's Hospital,Chengdu Sichuan,610072,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2019年第6期671-675,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
四川省卫生和计划生育委员会重点科研课题(20130537)~~
关键词
股骨颈骨折
股骨头缺血性坏死
关节囊内压
术前牵引
Femoral neck fracture
osteonecrosis of the femoral head
intracapsular pressure
preoperative traction