经皮加压钢板治疗中青年股骨颈骨折疗效分析

Midterm effectiveness of percutaneous compression plate for femoral neck fractures in young and middle-aged patients

目的 探讨经皮加压钢板(percutaneous compression plate,PCCP)治疗中青年股骨颈骨折的疗效。方法 回顾分析2011年1月—2019年3月采用PCCP内固定治疗且符合选择标准的173例中青年股骨颈骨折患者资料。其中男102例,女71例;年龄18~59岁,平均44.9岁。致伤原因:摔伤112例,交通事故伤32例,高处坠落伤21例,击打伤7例,扭伤1例。骨折按Garden分型:无移位型90例(Ⅰ型51例、Ⅱ型39例),移位型83例(Ⅲ型57例、Ⅳ型26例);按Pauwels分型:Ⅰ型10例,Ⅱ型88例,Ⅲ型75例。受伤至手术时间1~14 d,平均4.5 d。记录手术时间、术中出血量、围术期输血情况及住院时间;术后1 d通过Garden对线指数判断骨折复位质量;观察骨折愈合情况及并发症发生情况,末次随访时采用Harris评分评价疗效。结果 手术时间34~130 min,平均78.6 min;术中出血量10~250 mL,平均93.2 mL;171例围术期未输血,2例分别输血400 mL和800 mL;住院时间3~19 d,平均11.3 d。173例均获随访,随访时间11~103个月,平均42.6个月。术后X线片复查示复位质量满意170例,不满意3例。术后发生股骨头坏死13例、螺钉切出1例、退钉2例、股骨颈短缩5例,未发生需手术介入治疗的下肢深静脉血栓形成。172例患者骨折愈合,愈合时间3.0~7.5个月,平均3.6个月;1例骨折不愈合。51例患者于骨折愈合后取出内固定物。末次随访时Harris评分达优156例、良11例、可3例、差3例,优良率96.5%。结论 PCCP治疗中青年股骨颈骨折具有固定牢固、允许早期负重的优势,并有滑动加压功能,明显减少了骨不连和股骨头坏死的发生。

Objective To analyze midterm effectiveness of percutaneous compression plate(PCCP) for femoral neck fractures in young and middle-aged patients.Methods The clinical data of 173 young and middle-aged patients with femoral neck fractures who met the selection criteria and were treated with PCCP internal fixation between January 2011 and March 2019 were retrospectively analyzed.Among them,there were 102 males and 71 females;the age ranged from 18 to 59 years,with an average age of 44.9 years.The injury causes included falling in 112 cases,traffic accident in 32 cases,falling from height in 21 cases,struck in 7 cases,and sprain in 1 case.According to Garden classification,there were90 cases without displacement(51 cases of type Ⅰ and 39 cases of type Ⅱ) and 83 cases with displacement(51 cases of type Ⅲ and 39 cases of type Ⅳ).According to Pauwels classification,there were 10 cases of type Ⅰ,88 cases of type Ⅱ,and 75 cases of type Ⅲ.The time from injury to operation was 1-14 days,with an average of 4.5 days.The operation time,intraoperative blood loss,perioperative blood transfusion,and hospitalization stay were recorded;the fracture reduction was evaluated by Garden alignment index at 1 day after operation;fracture healing and complications were observed,and Harris score was used to evaluate the effectiveness at last follow-up.Results The operation time was 34-130 minutes(mean,78.6 minutes);the intraoperative blood loss was 10-250 mL(mean,93.2 mL);171 cases did not receive blood transfusion during perioperative period,2 patients received blood transfusion of 400 mL and 800 mL respectively;the hospitalization stay was 3-19 days(mean,11.3 days).All 173 cases were followed up 11-103 months,with an average of42.6 months.Postoperative reduction quality was satisfactory in 170 cases and unsatisfactory in 3 cases.There were 13 cases of osteonecrosis of femoral head,1 case of screw cutting out,2 cases of screw withdrawal,5 cases of femoral neck shortening,and no deep vein thrombosis in the lower extremity requiring surgical intervention.Fractures healed in 172 patients,and the healing time ranged from 3.0 to 7.5 months,with an average of 3.6 months;1 case of nonunion occurred.Internal fixation was removed after fracture healing in 51 patients.At last follow-up,Harris score was excellent in 156 cases,good in 11 cases,fair in 3 cases,and poor in 3 cases,with an excellent and good rate of 96.5%.Conclusion The treatment of femoral neck fractures with PCCP has advantages of rigid fixation,immediate weight-bearing,and sliding compression,reducing the incidences of osteonecrosis of femoral head and nonunion.