闭合复位技术治疗外展嵌插型股骨颈骨折

Treatment of abduction and insertion femoral neck fracture with closed reduction technique

目的:探讨C形臂X线监测下闭合复位技术3枚螺钉固定外展嵌插型股骨颈骨折的可行性。方法:回顾性分析2014年1月至2019年12月接受手术的17例外展嵌插型股骨颈骨折患者,男10例,女7例,年龄21~59(42.09±7.30)岁。根据术前的X线和CT资料,明确股骨头后倾及外展移位角度,2枚直径2 mm克氏针交叉从股骨头外侧和前方轻敲入髋臼顶盖骨质内,将近骨折段固定在髋臼上,在C形臂X线监测下逆骨折移位方向,逐渐内旋内收下肢(远骨折段),使远骨折端对合近骨折端完成解剖复位后3枚空心螺钉内固定。评价Garden指数,观察术后并发症,进行Harris功能评分。结果:17例外展嵌插型股骨颈骨折均顺利完成闭合复位内固定,手术时间36~68(43.87±7.63)min,术中出血15~50(28.36±5.93)ml。术中Garden指数评价骨折复位质量,解剖复位12例,可接受复位5例,无复位不成功改开放复位病例。17例获得随访,时间3~41(27.5±8.4)个月。无股骨头坏死、骨折不愈合、髋关节撞击征、股骨颈缩短等并发症出现,MRI检查未发现有股骨头坏死及关节软骨损伤表现。术后2年髋关节Harris评分优13例,良4例。结论:闭合复位3枚螺钉内固定手术技术治疗外展嵌插型股骨颈骨折可获得良好的解剖复位率及治疗效果。

Objective:To explore feasibility of closed reduction technique under monitoring of C-arm and three screws in the fixation of abduction and insertion femoral neck fracture.Methods:Seventeen patients with abduction and insertion femoral neck fracture operated from January 2014 to December 2019 were analyzed retrospectively,including 10 males and 7 females,aged from 21 to 59(42.09±7.30)years old.According to preoperative X-ray and CT data,angle of retroversion and abduction displacement of femoral head were determined.Two 2 mm diameter Kirschner wires crossed and gently knocked into the bone of the acetabular roof from outside and front of femoral head.The proximal fracture segment was fixed on the acetabulum.Under the monitoring of C-arm,lower limb(distal fracture segment)was gradually rotated inward and retracted against direction of fracture displacement,three cannulated screws were used for internal fixation after anatomical reduction of the distal fracture end and the proximal fracture end.Garden index was evaluated,postoperative complications were observed,and Harris functional score was performed.Results:All 17 cases of femoral neck fracture with abduction and insertion were successfully completed closed reduction and internal fixation.The operation time was 36 to 68(43.87±7.63)min and intraoperative bleeding was 15 to 50(28.36±5.93)ml.The quality of fracture reduction was evaluated by garden index during operation.There were 12 cases of anatomical reduction,5 cases of acceptable reduction,and no cases of unsuccessful reduction were changed to open reduction.17 cases were followed up for 3 to 41(27.5±8.4)months.There were no complications such as femoral head necrosis,fracture nonunion,hip impingement and femoral neck shortening.MR examination showed no femoral head necrosis and articular cartilage injury.Two years after operation,Harris score of hip joint was excellent in 13 cases and good in 4 cases.Conclusion:Closed reduction and three screws internal fixation can obtain good anatomical reduction rate and therapeutic effect in the treatment of abduction and insertion femoral neck fracture.