空心螺钉联合内侧支撑钢板治疗青壮年Pauwls Ⅱ、Ⅲ型股骨颈骨折

The cannulated screw combined with medial support plate in the treatment of Pauwls type Ⅱ,Ⅲ femoral neck fractures in young adults

目的 观察空心螺钉联合内侧支撑钢板治疗青壮年PauwlsⅡ、Ⅲ型股骨颈骨折的疗效。方法 采用空心螺钉联合内侧支撑钢板治疗60例青壮年PauwlsⅡ、Ⅲ型股骨颈骨折患者(61髋),记录术后骨折复位、愈合情况以及并发症发生情况。结果 患者均获得随访,时间9~36个月。术后摄骨盆正、轴位X线片复查,依据Garden对线指数评估骨折复位情况,Ⅰ级复位50例(51髋),Ⅱ级复位7例(7髋),Ⅲ级复位3例(3髋)。术后随访过程中,内固定松动退出或断裂4例(4髋),其中PauwelsⅡ型3例(3髋)、Ⅲ型1例(1髋);股骨颈短缩5例(5髋),均为PauwelsⅡ型;髋内翻畸形3例(3髋),其中PauwelsⅡ型2例(2髋)、Ⅲ型1例(1髋);骨折不愈合7例(7髋),其中PauwelsⅡ型5例(5髋)、Ⅲ型2例(2髋);股骨头坏死12例(12髋),其中PauwelsⅡ型9例(9髋)、Ⅲ型3例(3髋);无明显并发症、骨折达骨性愈合者29例(30髋)。结论 空心螺钉联合内侧支撑钢板并非是治疗青壮年PauwlsⅡ、Ⅲ型股骨颈骨折的金标准,其远期疗效有待进一步临床观察。

Objective To observe the effect of cannulated screw combined with medial support plate in the treatment of Pauwls typeⅡ,Ⅲfemoral neck fractures in young adults.Methods The 60 young patients with Pauwls typeⅡ,Ⅲfemoral neck fractures(61 hips)were treated by cannulated screw combined with medial support plate.The fracture reduction,healing conditions and complications were recorded.Results All patients were followed up for 9~36 months.Postoperative positive and axial radiographs of the pelvis were taken,and the fracture reduction was evaluated according to Garden alignment index.There were 50 cases(51 hips)of gradeⅠreduction,7 cases(7 hips)of gradeⅡreduction,and 3 cases(3 hips)of gradeⅢreduction.During postoperative follow-up,internal fixation loosened and exited in 4 cases(4 hips),including 3 cases(3 hips)of Pauwels typeⅡand 1 case(1 hip)of typeⅢ.Femoral neck shortening occurred in 5 cases(5 hips),they were all Pauwels typeⅡ.There were 3 cases of coxa varus deformity(3 hips),including 2 cases of Pauwels typeⅡ(2 hips)and 1 case of Pauwels typeⅢ(1 hip).There were 7 cases(7 hips)of nonunion,including 5 cases(5 hips)of Pauwels typeⅡand 2 cases(2 hips)of typeⅢ.There were 12 cases of femoral head necroses(12 hips),including 9 cases of Pauwels typeⅡand 3 cases of typeⅢ.The 29 cases(30 hips)reached bony healing without obvious complications.Conclusions In the treatment of young Pauwls typeⅡ,Ⅲfemoral neck fractures,the cannulated screw combined with medial support plate are not the gold standard,and its long-term efficacy needs to be further observed.