回顾分析青少年股骨颈骨折内固定术后中长期疗效

A retrospective analysis on mid-and long-term outcomes of internal fixation for femoral neck fractures in adolescents

目的:研究探讨青少年股骨颈骨折内固定治疗中长期疗效,评价骨折复位质量与股骨头缺血坏死骨不愈合、骨骺早闭、髋内翻、及疗效的关系。方法:回顾性分析2011年5月至2019年4月收治的34例内固定治疗青少年股骨颈骨折。Delbet分型Ⅰ型1例,Ⅱ型25例,Ⅲ型8例,其中闭合复位31例、切开复位3例。受伤后24 h内手术者8例,48 h内手术者14例,3天内手术者7例,4天内手术者5例。复位采用2~3枚空心钉内固定32例,锁定钢板固定2例。闭合复位中关节穿刺减压15例,关节囊切开减压3例。结果:全部患儿均获随访。手术治疗的34例患儿,31例一期愈合,其中6例患儿发生股骨头坏死,9例轻度髓内翻并短缩、9例骨骺早闭;2例复位欠佳患儿出现骨折延迟愈合,经再次手术翻修和植骨后愈合。骨折复位质量优21例、良8例、中4例、差1例,优良率85.2%,疗效标准根据Ratliff分级评价优24例、良7例、差3例,优良率91.2%。结论:青少年股骨颈骨折尽量早诊断、早治疗,采用闭合或切开解剖复位及空心螺钉内固定,复位轻柔,应当使内固定在获得好的把持力前提下尽量避免穿过骺板,可配合关节囊穿刺或切开减压。术后并发症主要与受伤时骨折类型,手术复位质量及固定方式有关,其中股骨头坏死主要跟骨折类型移位程度及复位质量有关,骨不愈合主要跟固定方式,及内固定失效有关。

Objective:To study the mid-and long-term outcomes of internal fixation for femoral neck fractures in adolescents,and to evaluate the association of fracture reduction with avascular necrosis and nonunion of femoral head,epiphyseal premature closure,coxa varus,and treatment outcomes.Methods:A retrospective analysis was conducted on 34 cases of internal fixation treatment for femoral neck fractures in adolescents admitted to our hospital between May 2011 and April 2019.According to Delbet classification system,the subjects comprised one case of type I,25 of type II,and 8 of type III femoral neck fractures.Among them,31 patients were treated with closed reduction and 3 with reduction.Eight patients were managed with within 24 h,14 within 48 h,7 within 3 days,and 5 within 4 days,after trauma.The reduction was followed by fixation with use of 2 to 3 hollow nails in 32 cases,and use of locking plate in 2 cases.Of patients receiving closed reduction,joint decompression was performed in 15 by paracentesis,and in 3 by capsulotomy.Results:All children were available for follow up.Of the 34 children treated by surgery,31 achieved primary healing.Among them,6 had femoral head necrosis,9 had mild intramedullary inversion and shortening,and 9 had epiphyseal premature closure.Two patients with poor reduction quality had delayed union of the fracture,and finally healed after redo surgery with bone grafting.The quality of fracture reduction was excellent in 21 cases,good in 8,fair in 4,and poor in 1 case,corresponding to excellent and good reduction in 85.2%of the children.According to the Ratliff classification,24 cases were rated as excellent,7 as good,and 3 as poor,corresponding to excellent and good outcome in 91.2%of the children.Conclusion:Femoral neck fractures in adolescents should be diagnosed and treated as early as possible,and subjected to closed or open anatomical reduction followed by internal fixation with hollow nails.The reduction should be manipulated with gentle maneuvers.Provided that a sufficient securing force can be ensured,the internal fixation should be averted to penetrate the epiphyseal plate as far as possible.Joint decompression can be used by paracentesis or capsulotomy if needed.Postoperative complications are mainly related to the type of fracture by injury,the quality of surgical reduction and the fixation method.Among these,femoral head necrosis is mainly related to the severity of bone displacement,fracture type and quality of reduction;bone nonunion is mainly related to the fixation method and failure of internal fixation.