Ganz入路埋头螺钉固定股骨头骨折

Herbert screw via Ganz approach for fixation of femoral head fracture

[目的]介绍Ganz入路埋头螺钉固定股骨头骨折的手术技术和初步临床结果。[方法] 2015年1月—2021年9月,对10例股骨头骨折患者采用Ganz入路埋头螺钉固定治疗。从髂后上棘下约5 cm处经大转子向大腿外侧中线向下做长12~20cm的切口,用摆锯自大转子顶点后上方至股骨外侧肌后缘纵向截骨,使大转子截骨块的厚约1.5 cm。将截下的大转子连同臀中肌、股外侧肌向前方牵开,显露关节囊,沿股骨颈的长轴偏向关节囊外侧“Z”形切开关节囊。屈曲、外旋股骨,将股骨头向前外侧脱位。清理髋关节关节腔内游离骨块及髋臼周围坏死、挫伤严重组织。复位股骨头较大骨块后用克氏针进行临时固定,根据骨块大小采用2~3枚直径2.4~3.5 mm埋头螺钉固定股骨头骨块并将钉尾埋到软骨下。内旋复位股骨头,复位大转子截骨块后以2枚皮质骨螺钉固定。[结果]所有患者均顺利完成手术,手术时间平均(139.5±30.5) min,术中出血量为(310.0±213.2) ml。恢复完全负重活动时间为术后3~6个月。术后6个月髋关节功能(Thompson-Epstein标准):优5例,良4例,可1例。[结论] Ganz入路埋头螺钉固定股骨头骨折,可充分显露髋臼及股骨头,能直视下复位骨折端,并发症发生率较低,具有良好的疗效。

[Objective] To introduce the surgical technique and preliminary clinical results of Herbert screw via Ganz approach for fixation of femoral head fracture. [Methods] Between January 2015 and September 2021, 10 patients underwent Herbert screw fixation of femoral head fractures via Ganz approach. After A 12~20 cm incision was made from about 5cm below the posterior superior iliac spine to the lateral midline of the thigh, longitudinal osteotomy of the greater trochanter was conducted with an oscillating saw from the posterior edge of the vastus lateralis, with 1.5cm greater trochanter bone block in thickness. The greater trochanter block with the gluteus medius and the vastus lateralis was pulled forward to expose the joint capsule, then the joint capsule was cut in a "Z" shape along the long axis of the femoral neck towards the lateral joint capsule. The femoral head was dislocated anterolaterally with flexion and external rotation maneuver. After debridement of the hip joint to remove blood clot the necrotic tissue, the fracture fragments of the femoral head were identified, reduced and fixed temporarily with Kirschner wires. Two to three countersunk cannulated screws with diameter of 2.4~3.5 mm were used to fix the femoral head bone fragments according to their size, with the screw tail buried under the cartilage. The femoral head was reduced by internal rotation and the greater trochanter osteotomy was fixed with two cortical screws. [Results] All patients had operation performed successfully with operation time of(139.5±30.5) min and intraoperative blood loss of(310.0±213.2) ml, and resumed full weight-bearing activity in 3~6months after surgery. At 6 months after surgery, hip function was marked as excellent in 5 cases, good in 4 cases, and fair in 1 case according to Thompson-Epstein criteria. [Conclusion] Ganz approach for countersunk screw fixation of femoral head fracture dose fully expose the acetabulum and femoral head, and facilitate to reduce the fracture under direct vision, with low complication rate and good curative effect.