外展嵌插伴后倾型股骨颈骨折术中解剖复位或可接受复位的术后疗效分析

Postoperative outcomes of intraoperative anatomical and acceptable reduction for femoral neck fractures with abduction insertion and posterior inclination

目的探讨外展嵌插伴后倾型的股骨颈骨折术中予以解剖复位或可接受复位的术后疗效。方法回顾性分析2015年1月至2022年1月北京大学第三医院延庆医院骨科行闭合复位空心钉固定手术的外展嵌插伴后倾型股骨颈骨折64例患者资料。男30例,女34例;年龄62.5(35.0,82.0)岁;根据复位情况将患者分为观察组(30例,解剖复位)和对照组(34例,可接受复位)。通过比较两组患者的手术时间、术中出血量、股骨颈短缩发生率、骨折愈合情况、缺血性坏死发生率、并发症发生率、功能Harris评分等比较疗效。结果两组患者术前基线资料比较差异均无统计学意义(P>0.05),具有可比性。所有患者术后随访时间为(23.4±12.8)个月。两组患者手术时间、术中出血量、缺血性坏死发生率、并发症发生率、Harris评分比较差异均无统计学意义(P>0.05)。围手术期两组患者均无伤口感染、心脑血管意外、深静脉血栓形成等并发症发生;术后长期随访两组患者骨折均愈合;观察组患者股骨颈短缩发生率6.7%(2/30)显著低于对照组29.4%(10/34),差异有统计学意义(P=0.026)。结论外展嵌插伴后倾型股骨颈骨折无论术中解剖复位或可接受复位,都能达到相对满意的结果。

ObjectiveTo investigate the postoperative outcomes of intraoperative anatomical and acceptable reduction in the treatment of femoral neck fractures with adductor insertion and posterior inclination.MethodsA retrospective study was conducted to analyze the 64 patients who had been treated at Department of Orthopedics,Yanqing Hospital,The Third Hospital of Peking University from January 2015 to January 2022 by closed reduction and hollow screw fixation for femoral neck fractures with adductor insertion and posterior inclination.There were 30 males and 34 females with an age of 62.5(35.0,82.0)years.The patients were divided into an observation group(30 cases with anatomical reduction)and a control group(34 cases with acceptable reduction).The therapeutic effects of 2 groups were compared in terms of surgical time,bleeding volume,incidence of femoral neck shortening,fracture healing,avascular necrosis incidence,incidence of complications,and Harris score.ResultsThere was no statistically significant difference between the 2 groups in the preoperative general data,indicating comparability(P>0.05).The follow-up time for all the patients was(23.4±12.8)months.There was no statistically significant difference between the 2 groups in surgical time,bleeding volume,avascular necrosis incidence,incidence of complications or Harris score(P>0.05).Perioperatively,neither group had any complications such as wound infection,cardiovascular accident,or deep vein thrombosis;long term follow-up showed fracture union in both groups;one case of femoral head necrosis occurred in each of the 2 groups;the incidence of femoral neck shortening in the observation group was 6.7%(2/30),significantly lower than that in the control group 29.4%(10/34)(P=0.026).ConclusionIn the treatment of femoral neck fractures with adductor insertion and posterior inclination,both intraoperative anatomical and acceptable reduction can achieve relatively satisfactory outcomes.