髋关节镜下空心钉固定青壮年股骨颈骨折

Arthroscopic cannulated screw fixation of femoral neck fracture in young adults

[目的]探讨由髋关节镜下复位空心钉固定治疗Garden Ⅲ~Ⅳ型青壮年股骨颈骨折的临床疗效。[方法]回顾性分析2018年1月—2020年12月手术治疗的40例Garden Ⅲ-Ⅳ型青壮年股骨颈骨折患者的临床资料。根据医患沟通结果,18例采用髋关节镜下复位空心钉固定(镜下组),22例采用传统切开复位空心钉固定术(传统组)。比较两组围手术期、随访及影像结果。[结果]所有患者均顺利完成手术,镜下组手术时间显著长于传统组[(98.0±7.6) min vs (72.8±6.0) min, P<0.05],但镜下组切口总长度[(36.27±4.3) mm vs (94.7±5.8) mm, P<0.05]、透视次数[(3.1±0.8)次vs (7.2±1.5)次, P<0.05]、术中出血量[(38.7±5.6) ml vs (245.5±39.6) ml, P<0.05]、住院时间[(7.1±1.2) d vs (9.0±1.8) d, P<0.05]均显著优于传统组。术后随访平均(41.4±10.4)个月,镜下组完全负重活动时间显著早于传统组[(92.6±1.8) d vs (106.4±4.3) d, P<0.05]。随时间推移,两组VAS评分、Harris]评分、髋伸-屈ROM、髋内旋-外旋ROM均显著改善(P<0.05)。术前两组VAS评分的差异无统计学意义(P>0.05),术后相应时间点,镜下组VAS评分、Harris评分、髋伸-屈ROM和髋内旋-外旋ROM均显著优于传统组(P<0.05)。影像方面,相应时间点,两组间Garden指数、颈干角、T?nnis髋OA分级差异均无统计学意义(P>0.05)。[结论]髋关节镜下复位空心钉固定治疗青壮年移位型股骨颈骨折可以在直视下进行骨折复位,术中出血少、手术创伤小、透视次数少、住院时间短、骨折愈合快、术后髋关节功能恢复好。

[Objective]To investigate the clinical outcomes of arthroscopic cannulated screw fixation for Garden type III-IV femoral neck fractures in young adults.[Methods]A retrospective study was conducted on 40 young adults who underwent surgical treatment for Garden type III-IV femoral neck fractures in our department from January 2018 to December 2020.According to doctor-patient communi⁃cation,18 patients underwent the arthroscopic reduction and fixation with percutaneous cannulated screws(the arthroscopic group),while the other 22 patients underwent traditional open reduction and internal fixation with cannulated screw(the traditional group).The periopera⁃tive,follow-up and imaging results were compared between the two groups.[Results]All patients in both groups had corresponding surgi⁃cal procedures performed successfully.Although the arthroscopic group consumed significantly longer operation time than the traditional group[(98.0±7.6)min vs(72.8±6.0)min,P<0.05],the former proved significantly superior to the latter in terms of incision length[(36.27±4.3)mm vs(94.7±5.8)mm,P<0.05],fluoroscopy times[(3.1±0.8)times vs(7.2±1.5)times,P<0.05],intraoperative blood loss[(38.7±5.6)ml vs(245.5±39.6)ml,P<0.05]and hospital stay[(7.1±1.2)days vs(9.0±1.8)days,P<0.05].All the patients were followed up for a mean of(41.4±10.4)months,and the arthroscopic group resumed full weight-bearing activity significantly earlier than the traditional group[(92.6±1.8)days vs(106.4±4.3)days,P<0.05].The VAS and Harris scores,as well as ranges of motion(ROMs)of hip extension-flexion and hip in⁃ternal-external rotation significantly improved over time in both groups(P<0.05).There was no significant difference in VAS scores be⁃tween the two groups before surgery(P>0.05),however,the arthroscopic group was significantly better than the traditional group in terms VAS score,Harris score,hip extension-flexion ROM and hip internal-rotation ROM at all corresponding time point after surgery(P<0.05).Radiographically,there were no significant differences in Garden index,shaft-neck angle and Tönnis hip osteoarthritis grade between the two groups at any time points accordingly(P>0.05).[Conclusion]The arthroscopic reduction and fixation with cannulated screws for displaced femoral neck fracture in young adults achieves manipulations under direct vision, with advantages of less intraoperative bleeding,less surgical trauma, less fluoroscopy times, shorter hospital stay, faster fracture healing, and better hip function recovery after surgery.