术前牵引对股骨颈骨折术后发生股骨头缺血性坏死的影响研究
|
摘要
目的探讨术前牵引对股骨颈骨折术后发生股骨头缺血性坏死(osteonecrosis of the femoral head,ONFH)的影响。方法以2013年2月—2016年5月行空心螺钉固定的股骨颈骨折患者作为研究对象,其中120例符合选择标准纳入研究。60例GardenⅠ、Ⅱ型患者为骨折无移位组,60例GardenⅢ、Ⅳ型为骨折移位组;两组患者均随机分为牵引、非牵引亚组,各亚组30例。骨折移位及无移位组中,两亚组患者性别、年龄、致伤原因、损伤侧别、受伤至手术时间以及骨折分型比较,差异均无统计学意义(P>0.05),具有可比性。术前记录患髋关节囊内压;术中复位固定后,评价骨折复位质量及螺钉植入满意率;术后6个月、1年、2年记录疼痛视觉模拟评分(VAS)、关节功能Harris评分、关节活动度,以及ONFH发生情况。结果两组术后切口均Ⅰ期愈合,无感染及下肢深静脉血栓形成等并发症发生。患者均获随访2年。骨折无移位及移位组中,牵引亚组囊内压均高于非牵引亚组(P<0.05);骨折复位质量及螺钉植入满意率比较,差异均无统计学意义(P>0.05)。术后6个月、1年及2年,牵引亚组患髋VAS评分高于非牵引亚组,关节活动度、Harris评分低于非牵引亚组,差异均有统计学意义(P<0.05)。X线片复查示骨折均愈合,除骨折无移位组术后6个月无ONFH发生外,其余时间点两组中牵引亚组ONFH发生率均高于非牵引亚组(P<0.05)。结论术前牵引可能增加ONFH发生风险,其作用机制之一可能是牵引增加髋关节囊内压,影响股骨头血供。
Objective To explore the impact of preoperative traction on the osteonecrosis of the femoral head(ONFH) in patients with femoral neck fractures. Methods Between February 2013 and May 2016, 120 patients with femoral neck fractures, who were treated with screw fixation, were collected. Sixty patients with fractures of Garden typeⅠ and Ⅱ were non-displaced fracture group; 60 cases with fractures of Garden type Ⅲ and Ⅳ were displaced fracture group. The patients in 2 groups were randomly divided into traction and non-traction subgroups(n=30). There was no significant difference in gender, age, injury mechanism, damage side, the time from injury to operation, and fracture classification between 2 subgroups(P>0.05). Intracapsular pressure was recorded before operation. The quality of fracture reduction and the satisfaction ratio of screw implant were evaluated during operation. Visual analogue scale(VAS), Harris score, joint mobility, and the incidence of ONFH would be evaluated at 6 months, 1 year, and 2 years after operation.Results All incisions of 2 groups healed by first intention after operation. There was no infection or deep vein thrombosis of lower extremity. All patients were followed up 2 years. In displaced and non-displaced fracture groups,the intracapsular pressure of traction subgroups were higher than that of non-traction group(P<0.05); the differences of the quality of fracture reduction and the satisfaction ratio of screw implant were not significant(P>0.05) between2 subgroups. At 6 months, 1 year, and 2 years after operation, VAS scores were higher in traction subgroup than in nontraction subgroup(P<0.05); and the joint mobility and Harris scores were lower in traction subgroup than in non-traction subgroup(P<0.05). X-ray films showed all fractures healed. Except for the non-displaced group at 6 months, the incidences of ONFH were higher in traction subgroup than in non-traction subgroup at other time points(P< 0.05).Conclusion Preoperative traction may increase the risk of ONFH, which can increase the intracapsular pressure and affect the blood supply of femoral head.
Objective To explore the impact of preoperative traction on the osteonecrosis of the femoral head(ONFH) in patients with femoral neck fractures. Methods Between February 2013 and May 2016, 120 patients with femoral neck fractures, who were treated with screw fixation, were collected. Sixty patients with fractures of Garden typeⅠ and Ⅱ were non-displaced fracture group; 60 cases with fractures of Garden type Ⅲ and Ⅳ were displaced fracture group. The patients in 2 groups were randomly divided into traction and non-traction subgroups(n=30). There was no significant difference in gender, age, injury mechanism, damage side, the time from injury to operation, and fracture classification between 2 subgroups(P>0.05). Intracapsular pressure was recorded before operation. The quality of fracture reduction and the satisfaction ratio of screw implant were evaluated during operation. Visual analogue scale(VAS), Harris score, joint mobility, and the incidence of ONFH would be evaluated at 6 months, 1 year, and 2 years after operation.Results All incisions of 2 groups healed by first intention after operation. There was no infection or deep vein thrombosis of lower extremity. All patients were followed up 2 years. In displaced and non-displaced fracture groups,the intracapsular pressure of traction subgroups were higher than that of non-traction group(P<0.05); the differences of the quality of fracture reduction and the satisfaction ratio of screw implant were not significant(P>0.05) between2 subgroups. At 6 months, 1 year, and 2 years after operation, VAS scores were higher in traction subgroup than in nontraction subgroup(P<0.05); and the joint mobility and Harris scores were lower in traction subgroup than in non-traction subgroup(P<0.05). X-ray films showed all fractures healed. Except for the non-displaced group at 6 months, the incidences of ONFH were higher in traction subgroup than in non-traction subgroup at other time points(P< 0.05).Conclusion Preoperative traction may increase the risk of ONFH, which can increase the intracapsular pressure and affect the blood supply of femoral head.
引文
1李智勇,孙然,张奇,等.2064例股骨颈骨折流行病学调查.中华创伤杂志,2009, 25(12):1064-1067.
2张英泽.股骨颈骨折治疗方案选择策略与进展.中国骨伤,2015,28(9):781-783.
3张弢,陈伟,张奇,等.早期干预预防股骨颈骨折并发症的临床研究.河北医药,2009, 31(2):226.
4李冀,李众利,苏祥正,等.小直径多孔道髓芯减压联合髋关节镜清理治疗早期股骨头缺血性坏死的疗效观察.中国修复重建外科杂志,2017, 31(9):1025-1030.
5顾小明,黄立新.股骨颈骨折空心加压螺钉内固定后股骨头坏死分析.实用骨科杂志,2014,20(10):900-905.
6谢康,高维陆,常俊,等.股骨颈骨折修复后股骨头坏死7个相关因素:199例回顾分析.中国组织工程研究,2016, 20(24):3529-3534.
7徐剑锋,邹祝艺,丁东胜,等.早期关节内减压加自体红骨髓移植联合治疗青壮年股骨颈骨折的临床应用.实用骨科杂志,2016,22(9):791-794.
8石利涛,刘彦博,杜金鹏,等.股骨颈骨折术中快速准确置人空心螺钉的手术技巧.湖南中医药大学学报,2016,(a2):1231-1232.
9曹延祥,赵燕鹏,胡磊,等.基于误差纠正算法的计算机辅助股骨颈骨折空心螺钉内固定系统的临床应用研究.中国修复重建外科杂志,2017, 31(3):257-261.
10朱乃彬,魏良熙.空心加压螺纹钉内固定及术后康复训练对股骨颈骨折患者髋膝关节功能的影响.中国临床康复,2005, 9(6):23-24.
11梁凡,彭昊,胡巍,等.股骨颈骨折术后继发股骨头坏死的危险因素分析.中华创伤杂志,2016, 32(9):813-817.
12曹发奇,周武,刘国辉,等.股骨颈骨折复位内固定术后股骨头坏死的相关因素分析.中华骨科杂志,2017, 37(17):1088-1092.
13 Hammer A. The structure of the femoral neck:A physical dissection with emphasis on the internal trabecular system. Ann Anat, 2010,192(3):168-177.
14王子华,赵德伟.基于显微灌注和三维数字成像的股骨头血供解剖学研究为青壮年股骨颈骨折治疗策略带来的新启示.中华显微外科杂志,2017, 40(5):417-418.
15赵德伟,邱兴.股骨头血液供应及其临床意义.临床外科杂志,2017,25(8):568-570.
16 Drake JK, Meyers MH. Intracapsular pressure and hemarthrosis following femoral neck fracture. Clin Orthop Relat Res, 1984,(182):172-176.
17华祖广,庞清江,郑兴国.股骨颈骨折后髋关节囊压力改变的临床研究.现代实用医学,2008, 20(1):11-12.
18伍凯,张明贵,曹云,等.股骨颈骨折后关节囊压力对股骨头血供的影响.中国矫形外科杂志,2002,10(10):984-986.
19王峰,方静,徐义,等.综合评价骨牵引、内固定与人工关节置换术治疗老年股骨颈骨折的疗效.中国厂矿医学,2007, 20(2):113-115.
20杨秀军,肖湘生.牵引、内旋位对股骨颈骨折早期股骨头血运影响的超选择DSA研究.中华放射学杂志,2005, 39(8):812-816.
21 Roden M, Schon M, Fredin H. Treatment of displaced femoral neck fractures:a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients. Acta Orthop Scand, 2003, 74(1):42-44.
2张英泽.股骨颈骨折治疗方案选择策略与进展.中国骨伤,2015,28(9):781-783.
3张弢,陈伟,张奇,等.早期干预预防股骨颈骨折并发症的临床研究.河北医药,2009, 31(2):226.
4李冀,李众利,苏祥正,等.小直径多孔道髓芯减压联合髋关节镜清理治疗早期股骨头缺血性坏死的疗效观察.中国修复重建外科杂志,2017, 31(9):1025-1030.
5顾小明,黄立新.股骨颈骨折空心加压螺钉内固定后股骨头坏死分析.实用骨科杂志,2014,20(10):900-905.
6谢康,高维陆,常俊,等.股骨颈骨折修复后股骨头坏死7个相关因素:199例回顾分析.中国组织工程研究,2016, 20(24):3529-3534.
7徐剑锋,邹祝艺,丁东胜,等.早期关节内减压加自体红骨髓移植联合治疗青壮年股骨颈骨折的临床应用.实用骨科杂志,2016,22(9):791-794.
8石利涛,刘彦博,杜金鹏,等.股骨颈骨折术中快速准确置人空心螺钉的手术技巧.湖南中医药大学学报,2016,(a2):1231-1232.
9曹延祥,赵燕鹏,胡磊,等.基于误差纠正算法的计算机辅助股骨颈骨折空心螺钉内固定系统的临床应用研究.中国修复重建外科杂志,2017, 31(3):257-261.
10朱乃彬,魏良熙.空心加压螺纹钉内固定及术后康复训练对股骨颈骨折患者髋膝关节功能的影响.中国临床康复,2005, 9(6):23-24.
11梁凡,彭昊,胡巍,等.股骨颈骨折术后继发股骨头坏死的危险因素分析.中华创伤杂志,2016, 32(9):813-817.
12曹发奇,周武,刘国辉,等.股骨颈骨折复位内固定术后股骨头坏死的相关因素分析.中华骨科杂志,2017, 37(17):1088-1092.
13 Hammer A. The structure of the femoral neck:A physical dissection with emphasis on the internal trabecular system. Ann Anat, 2010,192(3):168-177.
14王子华,赵德伟.基于显微灌注和三维数字成像的股骨头血供解剖学研究为青壮年股骨颈骨折治疗策略带来的新启示.中华显微外科杂志,2017, 40(5):417-418.
15赵德伟,邱兴.股骨头血液供应及其临床意义.临床外科杂志,2017,25(8):568-570.
16 Drake JK, Meyers MH. Intracapsular pressure and hemarthrosis following femoral neck fracture. Clin Orthop Relat Res, 1984,(182):172-176.
17华祖广,庞清江,郑兴国.股骨颈骨折后髋关节囊压力改变的临床研究.现代实用医学,2008, 20(1):11-12.
18伍凯,张明贵,曹云,等.股骨颈骨折后关节囊压力对股骨头血供的影响.中国矫形外科杂志,2002,10(10):984-986.
19王峰,方静,徐义,等.综合评价骨牵引、内固定与人工关节置换术治疗老年股骨颈骨折的疗效.中国厂矿医学,2007, 20(2):113-115.
20杨秀军,肖湘生.牵引、内旋位对股骨颈骨折早期股骨头血运影响的超选择DSA研究.中华放射学杂志,2005, 39(8):812-816.
21 Roden M, Schon M, Fredin H. Treatment of displaced femoral neck fractures:a randomized minimum 5-year follow-up study of screws and bipolar hemiprostheses in 100 patients. Acta Orthop Scand, 2003, 74(1):42-44.