微创切开复位结合股骨近端空心锁定钢板治疗PauwelsⅢ型股骨颈骨折的疗效分析

Minimally invasive open reduction combined with proximal femoral hollow locking plate in the treatment of Pauwells typeⅢfemoral neck fracture

目的探讨微创切开复位股骨近端空心锁定钢板内固定治疗PauwelsⅢ型股骨颈骨折的临床疗效。方法回顾性分析2012年3月—2018年8月武警天津总队医院和武警特色医学中心收治PauwelsⅢ型股骨颈骨折患者56例,男性32例,女性24例;年龄18~46岁,平均32.5岁。患者均行微创Watson-Jones入路切开复位及股骨近端空心锁定钢板髋关节内固定治疗,采用Garden对线指数评价骨折复位质量,记录所有患者并发症和骨折愈合情况;术后12个月随访时,使用Harris髋关节评分记录功能结果。结果手术时间61~97min,平均75.4min;术中出血量75~105mL,平均90.1mL。患者未发生围手术期深静脉血栓形成、肺栓塞或尿路感染等并发症。患者复位后Garden对线指数均为Ⅰ级。需要再次手术5例(股骨骨不连2例,股骨头坏死3例)。2019年12月末次随访时Harris髋关节评分75~98分,平均91.9分,末次随访时Harris髋关节评分优良率91.07%(51/56)。结论微创切开复位股骨近端空心锁定钢板内固定治疗PauwelsⅢ型股骨颈骨折复位质量高,固定牢靠,术后效果满意,值得临床推广。

Objective To investigate the clinical effect of minimally invasive open reduction and internal fixation with proximal femoral hollow locking plate in the treatment of Pauwels typeⅢfemoral neck fracture.Methods The clinical data of 56 patients(32 males and 24 females)with Pauwels type III femoral neck fracture from Tianjin General Hospital of PAPF and Characteristic Medical Center of PAPF from Mar.2012 to Aug.2018 were analyzed retrospectively.All patients received minimally invasive Watson-Jones approach open reduction and proximal femur hollow locking plate hip joint internal fixation.Garden’s index was used to evaluate the quality of fracture reduction.The complications and fracture healing were recorded.At the postoperative 12 months of follow-up,Harris hip score was used to record the functional results.Results The average operation time was 61-97 minutes,with an average of 75.4 minutes.The intraoperative blood loss was 75-105 mL,with an average of 90.1 mL.All patients had Grade I Garden’s index after reduction.However,5 patients needed reoperation(2 cases of nonunion,3 cases of necrosis of the femoral head).At the last follow-up,the average Harris hip score was 75-98 points,with an average of 91.9 points.The excellent and good rate of Harris hip score was 91.07%.Conclusion Minimally invasive proximal femoral hollow locking plate internal fixation for the treatment of Pauwels type III femoral neck fracture has high quality of reduction,reliable fixation,and satisfactory postoperative effect,which is worthy of clinical promotion.