直接前方入路空心螺钉固定治疗青壮年难复性股骨颈骨折

Cannulated screw fixation directly via the anterior approach for femoral neck fractures difficultly reducible in young and middle-aged patients

目的探讨直接前方入路切开复位空心螺钉固定治疗青壮年GardenⅣ型难复性股骨颈骨折的临床疗效。方法回顾性分析2015年3月至2017年10月期间福建医科大学附属闽东医院创伤骨科采用直接前方入路切开复位空心螺钉固定治疗的40例年龄<65岁的难复性股骨颈骨折患者资料。男28例,女12例;年龄为22~62岁,平均49.2岁;骨折Garden分型:均为Ⅳ型。受伤至手术时间为1~6 d,平均3.2 d。记录患者的股骨颈骨折不愈合及股骨头缺血性坏死的发生情况,并根据Garden指数、髋关节Harris评分标准评定骨折复位质量及髋关节功能。结果40例患者术后获11~44个月(平均22.3个月)随访。随访期间1例患者发生骨折不愈合,二期行人工全髋关节置换术;无一例患者发生股骨头缺血性坏死。40例患者术后2 d与末次随访时的正位Garden指数分别为156.97°±1.40°、157.07°±1.47°,差异无统计学意义(t=-0.302,P=0.765);侧位Garden指数分别为171.82°±4.48°、172.10°±4.27°,差异无统计学意义(t=-2.333,P=0.817)。末次随访时40例患者的髋关节Harris评分为77~98分,平均92分;优31例,良6例,可2例,差1例,优良率为92.5%。结论当青壮年GardenⅣ型难复性股骨颈骨折闭合复位无法获得满意效果时,直接前方入路切开复位空心螺钉内固定可直视下完成骨折的复位与固定,骨折愈合率高,股骨头缺血性坏死率低,近期临床疗效满意。

Objective To investigate the clinical outcomes of open reduction and cannulated screw fixation directly via the anterior approach for femoral neck fracture of Garden typeⅣwhich is difficultly reducible in young and middle-aged patients.Methods Forty patients aged younger than 65 years old were treated by open reduction and cannulated screw fixation directly via the anterior approach for femoral neck fractures which were difficulty reducible at Department of Orthopaedics,Mindong Hospital from March 2015 to October 2017.They were 28 males and 12 females,aged from 22 to 62 years(mean,49.2 years).All the fractures were typeⅣby the Garden classification.The time from injury to operation averaged 3.2 d(range,from 1 to 6 d).Their postoperative fracture nonunion and femoral head necrosis were recorded.The reduction quality and hip function were evaluated using Garden reduction index and Harris hip scores.Results All the 40 patients were followed up for 11 to 44 months(mean,22.3 months).Nonunion occurred in one patient who had to accept secondary artificial hip replacement.No avascular necrosis of the femoral head occurred in any patients.The anteroposterior Garden reduction indexes at 2 d after surgery and at the last follow-up for the 40 patients were respectively 156.97°±1.40°and 157.07°±1.47°,showing no significant difference(t=-0.302,P=0.765);so were the lateral Garden reduction indexes(171.82°±4.48°and 172.10°±4.27°)(t=-2.333,P=0.817).The Harris hip scores at the final follow-up for the hip ranged from 77 to 98(average,92);31 cases were rated as excellent,6 as good,2 as fair and one as poor,giving an excellent to good rate of 92.5%.Conclusion In the treatment of femoral neck fracture of Garden typeⅣwhich is difficultly reducible in young and middle-aged patients,if closed reduction has failed,open reduction and cannulated screw fixation directly via the anterior approach can achieve satisfactory short-term outcomes because it facilitates fracture reduction and fixation under direct vision,promotes fracture union and reduces avascular necrosis of the femoral head.