直接前方入路切开复位空心钉内固定治疗青壮年难复性股骨颈骨折

Application of open reduction through anterior small incision and percutaneous hollow lag screw fixation for irreducible femoral neck fracture in young adults

背景:目前对于青壮年股骨颈骨折患者的治疗仍存在争议。目的:探讨直接前方微创小切口切开复位联合经皮空心拉力螺钉固定治疗青壮年难复性股骨颈骨折患者的方法及疗效。方法:2013年1月2016年6月对23例股骨颈骨折患者采用前方小切口切开复位联合经皮3枚空心拉力螺钉固定治疗,其中男17例,女6例,平均年龄(43.2±3.4)岁,均为Garden Ⅳ型,且闭合复位失败的病例。受伤至手术时间为1~3 d。术后复查X线检查观察骨折愈合情况及是否发生股骨头坏死等。在术后即刻和术后12个月患者X线片上测量患肢的Garden指数,并进行比较。对疑有股骨头坏死者行CT或MRI检查。评价髋关节疼痛、功能、畸形及运动范围情况,进行Harris评分。结果:23例患者均获得随访,随访时间12~40个月,平均随访(30.3±1.4)个月。所有患者术后即刻和术后12个月X线检查均获得GardenⅠ、Ⅱ级复位,随访过程中无一例发生骨折不愈合、骨折再次移位及空心螺钉后退。术后即刻与术后12个月患者患肢正、侧位Garden复位指数差异均无统计学意义[(166.4±3.1)°vs(163.1±3.7)°,t=0.614,P=0.496;(170.3±4.3)°vs(168.3±5.3)°,t=0.522,P=0.482]。末次随访髋关节功能Harris评分为82~98分,平均(93.3±4.7)分;优19例,良4例,优良率为100%。结论:采用前方小切口切开复位联合经皮空心拉力螺钉固定治疗青壮年难复性股骨颈骨折患者手术操作简便、创伤小、愈合率高、疗效良好,是一种理想的微创方法。

Background: The treatment of femoral neck fractures in young adults is still in dispute. Objective: To investigate the clinical outcomes of open reduction through anterior small incision and percutaneous hollow lag screw fixation for irreducible femoral neck fracture. Methods: From January 2013 to June 2016, 23 patients with femoral neck fractures were treated with open reduction through anterior small incision combined with percutaneous three hollow screw fixation. There were 17 males and 6 females with a mean age of(43.2±3.4) years. All the injuries were classified to Garden Ⅳ type, and closed reduction failed in all the patients. The patients received operations at 1-3 d after injury. Fracture healing and necrosis of the femoral head were observed by X-ray after operation. The Garden index of the affected limb was measured on the X-ray film immediately and 12 months after operation. CT or MRI were performed in the patients with suspected femoral head damage. The pain, function, deformity and range of motion of hip joint were evaluated and Harris score was used. Results: All the patients were followed up for(30.3±1.4) months(range, 12-40 months). Garden I and II reduction was achieved in all the patients immediately and 12 months after operation. No nonunion, fracture displacement, or hollow screw regression was found during follow up. Both anteroposterior and lateral Garden reduction indexes at 12 months after operation were not significant different from those immediately after operation(166.4°±3.1° vs 163.1°±3.7°, t=0.614, P=0.496;170.3°±4.3° vs 168.3°±5.3°, t=0.522,P=0.482). Harris score of hip joint function at the last follow-up was 93.3±4.7 on average(range, 82-98). The result was excellent in 19 cases and good in 4 cases. Conclusions: Open reduction through anterior small incision combined with percutaneous hollow screw fixation is a perfect minimally-invasive method for irreducible femoral neck fracture. It has the advantages of simple operation, small trauma, high healing rate and good curative effect.