股骨颈骨折内固定治疗的探讨

Internal Fixation of the Femoral Neck Fracture

目的 :探讨股骨颈骨折 4种内固定方法的效果。方法 :回顾性分析 10 7例股骨颈骨折 ,分别采用三翼钉 ,加压螺钉 ,多针固定 ,肌蒂骨瓣移植加固定 4种方法。对比骨折愈合率、髋关节功能恢复、股骨头坏死发生率。结果 :三翼钉固定 2 1例 ,加压螺钉固定 2 5例 ,多针固定 3 5例 ,带肌蒂骨瓣移植加内固定 2 6例。骨折愈合 89例 ( 83 .1% ) ,髋关节功能优良 75例 ( 84.2 % ) ,差 11例 ( 12 .3 % ) ,骨折不愈合 18例 ( 16.9% ) ,股骨头坏死 2 1例 ( 19.5 % )。结论 :内固定手术对股骨颈骨折有意义。 70岁以下的患者均可应用。三翼钉的骨折愈合率低 ,股骨头坏死发生率高 ,不宜采用 ;加压螺钉操作简单 ,固定牢固 ,但股骨头坏死率较高 ,不宜作为首选方法 ;多针内固定操作简单 ,骨折愈合率高 ,可作首选内固定 ;肌蒂骨瓣移植加内固定治疗骨折愈合率高 ,但手术操作复杂 ,不适合老年患者。

Objective:To discuss the effect of four means of internal fixation for the femoral neck fracture.Method:A retrospetive analysis of different methods and results were made in 107 cases of femoral neck fractures in adults.Result:Twenty-one cases by Smith-Peterson nail,15 cases union(union rate 71.4%),necrosis 7 cases(38%);25 cases by compress screw,21 cases union(84%),necrosis 8 cases(21.1%);35 cases by mutiple nails,31 cases union(90%),necrosis 4cases(11.4%);26 cases by muscle-pedicle bone grafting add internal fixation,24 cases union(92%),2 cases necrosis(8.3%).In all of the 107 cases,89 cases union(83.1%),21 cases necrosis(19.6%).Conclusion:Internal fixation should be the first choice to treats the femoral neck fracture in patients younger than 70 years.The complication of Smith-Peterson nail is too high being not an appreciated method.Compress screwing is simple and solid fixation but the injury and necrosis rate are also high,not suitable for the first choice.Mutiple nailing is simple and solid fixation and the injury is small,union rate is high.It could be the appreciated way.The muscle-pedicle bone grafting add internal fixation can get high union rate but the operation is more sophisticated and the injury is too high unsuitable for elderly patient.