两种入路开放复位内固定股骨头骨折比较

Comparison of two approaches for open reduction and internal fixation of femoral head fractures

[目的]比较Ganz入路与Kocher-Langenbeck(K-L)入路开放复位内固定PipkinⅠ、Ⅱ型股骨头骨折的临床疗效。[方法]回顾性分析2017年4月—2022年2月本院治疗的24例股骨头骨折患者的临床资料,根据医患沟通结果,12例采用Ganz入路,另外12例采用K-L入路,比较两组临床和影像结果。[结果]两组患者均顺利完成手术,Ganz组在手术时间[(94.6±15.1)min vs(109.2±14.6)min,P=0.025]和术中失血量[(254.2±78.2)ml vs(316.7±65.1)ml,P=0.045]均显著优于K-L组,两组切口长度、切口愈合等级的差异均无统计学意义(P>0.05)。随访时间平均(17.1±8.4)个月,术后随时间推移,两组疼痛视觉模拟评分(visual analogue scale,VAS)及Harris评分显著增加(P<0.05),术后1个月Ganz组的Harris评分显著优于K-L组[(44.1±2.5)vs(40.2±3.0),P=0.002],其他相应时间点,两组VAS、Harris评分的差异均无统计学意义(P>0.05)。影像方面,两组骨折复位质量的差异无统计学意义(P>0.05)。末次随访时,两组Brooker分级、Ficat分期及Tonnis分级的差异均无统计学意义(P>0.05)。[结论]相较于K-L入路,Ganz入路具有手术时间短、术中出血少、术后髋关节功能恢复快等优势。

[Objective]To compare the clinical efficacy of Ganz approach versus Kocher-Langenbeck(K-L)approach for open reduc-tion and internal fixation(ORIF)of Pipkin type I and II femoral head fractures.[Methods]A retrospective study was conducted on 24 pa-tients who receive ORIF of femoral head fractures in our hospital from April 2017 to February 2022.According to the results of doctor-pa-tient communication,12 patients had ORIF performed through the Ganz approach,while the other 12 patients were through K-L approach.The clinical and imaging documents of the two groups were compared.[Results]All patients in both groups were successfully operated on.The Ganz group proved significantly superior to the K-L group in terms of operative time[(94.6±15.1)min vs(109.2±14.6)min,P=0.025]and intraoperative blood loss[(254.2±78.2)ml vs(316.7±65.1)ml,P=0.045],despite of insignificant differences in incision length and inci-sion healing grade between the two groups(P>0.05).As time went during follow-up period lasted for(17.1±8.4)months in a mean,the visu-al analogue scale(VAS)for pain and Harris score of the two groups were significantly increased(P<0.05).The Ganz group was significantlybetter than the K-L group regarding Harris score one month after surgery[(44.1±2.5)vs(40.2±3.0),P=0.002],regardless of the fact thatthere were no significant differences in VAS score,and Harris score at other corresponding time points between the two groups(P>0.05).Radiographically,there was no significant difference in fracture reduction quality between the two groups(P>0.05).At the last follow-up,there were no significant differences in Brooker grade,Ficat stage and Tonnis grade between the two groups(P>0.05).[Conclusion]TheGanz approach has the advantages of shortening operation time,reducing intraoperative bleeding,and improving recovery of hip function af-ter operation over the K-L approach for femoral head fractures.