改良Smith-Petersen入路治疗中青年难复性股骨颈骨折的中长期随访结果分析

Med- to long-term clinical outcomes of modified Smith-Petersen approach in treatment of irreducible femoral neck fracture in young adults

目的探讨改良Smith-Petersen入路切开复位内固定治疗中青年难复性股骨颈骨折的中长期临床疗效。方法回顾性分析2009年12月至2015年2月期间北京积水潭医院创伤骨科采用改良Smith-Petersen入路治疗且获得随访的16例中青年难复性股骨颈骨折患者资料。男11例,女5例;年龄为19~59岁,平均42.9岁;均为闭合性骨折;高能量损伤8例,低能量损伤8例。骨折Garden分型均为Ⅳ型。受伤至手术时间为1~11 d,平均5.4 d。所有患者均先行牵引床闭合复位,经连续3次整复骨折不能达到理想复位,改行改良Smith-Petersen入路切开复位空心螺钉内固定治疗。记录患者的术后完全负重时间、恢复工作时间、骨折愈合时间、末次随访时患髋功能及并发症发生情况等。结果16例患者术后获6~12年(平均8.8年)随访。16例患者术后完全负重时间为2~16周,平均12.7周。15例患者恢复工作时间平均为15.0周(3~20周),骨折临床愈合时间平均为3.5个月(3~6个月);另1例患者骨折不愈合。末次随访时16例患者的髋关节Harris评分为62~98分,平均90.3分;优12例,良2例,可1例,差1例。1例患者因骨折不愈合行全髋关节置换术,4例出现股骨头缺血性坏死患者中2例行全髋关节置换术。1例患者出现髋关节周围异位骨化,髋关节活动受限。结论对于中青年股骨颈骨折闭合复位不成功的患者,采用改良Smith-Petersen入路可直视下完成骨折复位,中长期疗效满意。

Objective To investigate the med-to long-term clinical outcomes of open reduction and cannulated screw fixation via the modified Smith-Petersen approach for irreducible femoral neck fractures in young adults.Methods The clinical data of 16 young adults were retrospectively studied who had been treated for irreducible femoral neck fractures by open reduction and cannulated screw fixation via the modified Smith-Petersen approach by the same surgeon from December 2009 to February 2015 at Department of Orthopaedics and Traumatology,Beijing Jishuitan Hospital.There were 11 males and 5 females aged from 19 to 59 years(average,42.9 years).All their fractures were closed Garden typeⅣ,with high energy injury in 8 cases and low energy injury in the other 8 ones.The time from injury to surgery averaged 5.4 d(from 1 to 11 d).In all the patients,open reduction and cannulated screw fixation via the modified Smith-Petersen approach was conducted after ideal reduction had not been achieved by 3 continuous attempts in primary closed reduction in a traction bed.Recorded were the postoperative full weight-bearing time,return to work time,fracture union time,function of the affected hip and complications at the last follow-up in the patients.Results The 16 patients were followed up for 6 to 12 years(average,8.8 years).The postoperative full weight-bearing time averaged 12.7 weeks(from 2 to 16 weeks)in 16 patients;the return to work time averaged 15.0 weeks(from 3 to 20 weeks)and the fracture union time 3.5 months(from 3 to 6 months)in 15 patients while fracture nonunion happened in the other one.The HSS hip scores at the last follow-up averaged 90.3 points(from 62 to 98 points),yielding 12 excellent,2 good,one fair and one poor cases.The one case with fracture nonunion underwent total hip arthroplasty(THA);of the 4 cases with avascular necrosis of the femoral head,2 underwent THA;limited range of hip motion due to heterotopic ossification was noted in one case.Conclusion Open reduction and cannulated screw fixation via the modified Smith-Petersen approach may lead to fine med-to long-term clinical outcomes in young adults whose femoral neck fracture cannot be reduced by closed reduction,because the modified Smith-Petersen approach allows fracture reduction under direct vision.