2枚空心钉内固定治疗股骨颈骨折Garden Ⅰ Ⅱ Ⅲ型临床疗效分析

Clinical analysis of two cannulated screws internal fixation in treatment of Garden Ⅰ,Ⅱ and Ⅲ fractures of the femoral neck

目的分析2枚空心钉内固定治疗股骨颈骨折GardenⅠ、Ⅱ、Ⅲ型闭合复位的临床疗效。方法收集该院2013-01~2017-08收治股骨颈骨折患者85例,均为新鲜性非病理性股骨颈骨折,Garden分型分别为Ⅰ、Ⅱ、Ⅲ型,行2枚空心钉内固定组(简称2枚组)45例:GardenⅠ型18例,Ⅱ型11例,Ⅲ型16例;行3枚空心钉内固定组(简称3枚组)40例:GardenⅠ型13例,Ⅱ型9例,Ⅲ型18例。同时收集相关临床资料,85例随访12~24(20.26±2.68)个月。评估骨折愈合及股骨头坏死情况,采用髋关节功能Harris评分评估术后临床功能疗效。结果2枚组有42例获得愈合,愈合率为93.33%,15例术后因骨性愈合已取出内固定钉,3例出现股骨头缺血性坏死。3枚组有38例获得愈合,愈合率为95.00%,2例出现股骨头缺血性坏死。两组愈合率差异无统计学意义(P>0.05)。髋关节功能Harris评分结果2枚组(89.70±8.82)分,36例为优,4例为良,2例为可,3例为差,优良率为88.89%;3枚组(91.53±8.38)分,35例为优,2例为良,1例为可,2例为差,优良率为92.50%。两组Harris评分和优良率差异无统计学意义(P>0.05)。结论股骨颈骨折GardenⅠ、Ⅱ、Ⅲ型闭合复位2枚空心钉内固定治疗可获得满意的临床疗效。

Objective To analyze the clinical effects of closed reduction of GardenⅠ,ⅡandⅢfractures of the femoral neck treated by two cannulated screws internal fixation.Methods Eighty-five cases of femoral neck fractures which were fresh non-pathological femoral neck fractures were collected in our hospital from January 2013 to August 2017.Garden was classified as typeⅠ,ⅡandⅢ.45 cases releived two cannulated screws internal fixation(three-screw group):18 cases of Garden typeⅠ,11 cases of typeⅡ,and 16 cases of typeⅢ.40 cases releived 3 cannulated screws internal fixation(two-screw group):13 cases of Garden typeⅠ,9 cases of typeⅡ,and 18 cases of typeⅢ.At the same time,related clinical data were collectied,and 85 cases were followed up for 12~24 months,with an average of(20.26±2.68)months.The fracture healing and necrosis of the femoral head were evaluated,and Harris score of hip joint function was used to evaluate the clinical effects after operation.Results In the 45 cases who were fixed with two cannulated screws,42 cases were healed with a healing rate of 93.33%,among whom the internal fixation nails were removed in 15 cases due to bone healing and necrosis of femoral head occurred in 3 cases.In the 40 cases who were fixed with 3 cannulated screws,38 cases were healed with a healing rate of 95.00%,among whom necrosis of femoral head occurred in 2 cases.There was no significant difference in the healing rate between the two groups(P>0.05).In the 45 cases who were fixed with two cannulated screws,all the patients had an average of Harris score of hip joint function being(89.70±8.82)points,36 cases were excellent,4 cases good,2 cases fair and 3 cases poor,with an excellent and good rate of 88.89%.In the 40 cases who were fixed with 3 cannulated screws,all the patients had an average of Harris score of hip joint function being(91.53±8.38)points,35 cases were excellent,2 cases good,1 case fair and 2 cases poor,with an excellent and good rate of 92.50%.There were no significant differences in Harris score and excellent and good rate between the two groups(P>0.05).Conclusion Two cannulated screws internal fixation is clinically effective in treatment of closed reduction of GardenⅠ,ⅡandⅢfractures of the femoral neck.