空心钉联合内侧支撑钢板固定治疗青壮年GardenⅢ、Ⅳ型股骨颈骨折的疗效
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摘要
目的观察空心钉联合内侧支撑钢板固定治疗青壮年GardenⅢ、GardenⅣ型股骨颈骨折的临床疗效。方法回顾性分析2016年1月～2018年2月我院收治的21例青壮年GardenⅢ、GardenⅣ型股骨颈骨折患者,所有患者均通过前侧阔筋膜张肌及缝匠肌间隙入路置入股骨颈内侧支撑钢板,采用Garden指数评价骨折复位情况,Harris评分及VAS评分评价术后髋关节功能。结果术后DR片显示21例骨折均达到GardenⅠ级解剖复位标准,末次随访时内固定在位,未出现股骨头坏死、骨折不愈合、内固定断裂等情况;手术优良率为100.00%,术后12个月Harris评分高于术前[(90.46±2.69)分vs (48.08±3.82)分],差异有统计学意义(P<0.05);VAS疼痛评分为低于术前[(2.07±0.64)分vs(8.23±0.60)分],差异有统计学意义(P<0.05)。结论前侧直接入路有限切开复位空心钉联合内侧支撑钢板固定治疗青壮年GardenⅢ、GardenⅣ型股骨颈骨折可行、有效,有助于降低骨折不愈合及股骨头缺血性坏死发生率。
Objective To observe the clinical efficacy of cannulated screws combined with medial support plate fixation for the treatment of femoral neck fractures of Garden Ⅲ and Garden Ⅳ in young adults. Methods A retrospective analysis of 21 cases of young and middle-aged Garden Ⅲ and Garden Ⅳ femoral neck fractures admitted to our hospital from January 2016 to February 2018, all patients were placed through the anterior tensor fascia lata and sartorius muscle gap approach. The medial femoral neck was supported by the plate. The Garden index was used to evaluate the fracture reduction. The Harris score and VAS score were used to evaluate the hip function. Results Postoperative DR showed that 21 cases of fractures reached the Grade I anatomical reduction criteria. At the last follow-up, the patients were fixed in place. There was no femoral head necrosis, fracture nonunion, internal fixation fracture, etc. The excellent and good rate of operation was 100.00%. The 12-month Harris score was higher than preoperative [(90.46±2.69) points vs(48.08±3.82) points], the difference was statistically significant(P<0.05); the VAS pain score was lower than preoperative [(2.07±0.64) points vs(8.23±0.60) points,the difference was statistically significant(P<0.05). Conclusion The anterior direct approach with limited open reduction and cannulated screws combined with medial support plate fixation is feasible and effective in the treatment of young and middle-aged Garden Ⅲ and Garden Ⅳ femoral neck fractures, which is helpful to reduce the incidence of nonunion and avascular necrosis of the femoral head.
Objective To observe the clinical efficacy of cannulated screws combined with medial support plate fixation for the treatment of femoral neck fractures of Garden Ⅲ and Garden Ⅳ in young adults. Methods A retrospective analysis of 21 cases of young and middle-aged Garden Ⅲ and Garden Ⅳ femoral neck fractures admitted to our hospital from January 2016 to February 2018, all patients were placed through the anterior tensor fascia lata and sartorius muscle gap approach. The medial femoral neck was supported by the plate. The Garden index was used to evaluate the fracture reduction. The Harris score and VAS score were used to evaluate the hip function. Results Postoperative DR showed that 21 cases of fractures reached the Grade I anatomical reduction criteria. At the last follow-up, the patients were fixed in place. There was no femoral head necrosis, fracture nonunion, internal fixation fracture, etc. The excellent and good rate of operation was 100.00%. The 12-month Harris score was higher than preoperative [(90.46±2.69) points vs(48.08±3.82) points], the difference was statistically significant(P<0.05); the VAS pain score was lower than preoperative [(2.07±0.64) points vs(8.23±0.60) points,the difference was statistically significant(P<0.05). Conclusion The anterior direct approach with limited open reduction and cannulated screws combined with medial support plate fixation is feasible and effective in the treatment of young and middle-aged Garden Ⅲ and Garden Ⅳ femoral neck fractures, which is helpful to reduce the incidence of nonunion and avascular necrosis of the femoral head.
引文
[1]周俊,周传友,陈武.青壮年移位型股骨颈骨折(GardenⅢ、Ⅳ)的手术治疗[J].中国医药科学,2014(16):202-204.
[2]Huang TW,Hsu WH,Peng KT,et al.Effect of integrity of the posterior cortex in displaced femoral neck fractures on outcome after surgical fixation in young adults[J].Journal of the Care of the Injured,2011,42(2):217-222.
[3]丁强,孙楠,吴非燃,等.空心钉附加内侧支撑钢板内固定治疗青壮年非头下型股骨颈骨折的疗效观察[J].中国骨与关节损伤杂志,2018,33(5):534-535.
[4]叶永杰,王秀敏,银毅,等.空心钉锁定板与加压空心螺钉治疗青壮年股骨颈骨折疗效对比[J].中国药业,2014(15):91-93.
[5]李锐军,蔡荣辉,何智勇.全髋关节置换术后关节功能4种定量指标变化及Harris评分分析[J].中国骨科临床与基础研究杂志,2017,9(2):81-85.
[6]刘浩宗,陈源,陈浩波,等.空心钉内固定联合缝匠肌带蒂骨瓣移植治疗青壮年移位型股骨颈骨折(GardenⅢ、Ⅳ型)临床分析[J].岭南急诊医学杂志,2016,21(3):287-289.
[7]Popelka O,Skálarosenbaum J,Bartoska R,et al.Fracture Type and Injury-to-Surgery Interval as Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Intracapsular Femoral Neck Fracture[J].Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca,2015,82(4):282.
[8]柴斌,李康养,丁文彬,等.股骨颈骨折空心加压螺钉内固定术后股骨头坏死的原因分析[J].中国骨与关节损伤杂志,2017,32(2):182-184.
[9]Song HK,Choi HJ,Yang KH.Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years[J].Journal of the Care of the Injured,2016,47(12):2743-2748.
[2]Huang TW,Hsu WH,Peng KT,et al.Effect of integrity of the posterior cortex in displaced femoral neck fractures on outcome after surgical fixation in young adults[J].Journal of the Care of the Injured,2011,42(2):217-222.
[3]丁强,孙楠,吴非燃,等.空心钉附加内侧支撑钢板内固定治疗青壮年非头下型股骨颈骨折的疗效观察[J].中国骨与关节损伤杂志,2018,33(5):534-535.
[4]叶永杰,王秀敏,银毅,等.空心钉锁定板与加压空心螺钉治疗青壮年股骨颈骨折疗效对比[J].中国药业,2014(15):91-93.
[5]李锐军,蔡荣辉,何智勇.全髋关节置换术后关节功能4种定量指标变化及Harris评分分析[J].中国骨科临床与基础研究杂志,2017,9(2):81-85.
[6]刘浩宗,陈源,陈浩波,等.空心钉内固定联合缝匠肌带蒂骨瓣移植治疗青壮年移位型股骨颈骨折(GardenⅢ、Ⅳ型)临床分析[J].岭南急诊医学杂志,2016,21(3):287-289.
[7]Popelka O,Skálarosenbaum J,Bartoska R,et al.Fracture Type and Injury-to-Surgery Interval as Risk Factors for Avascular Necrosis of the Femoral Head after Internal Fixation of Intracapsular Femoral Neck Fracture[J].Acta Chirurgiae Orthopaedicae Et Traumatologiae Cechoslovaca,2015,82(4):282.
[8]柴斌,李康养,丁文彬,等.股骨颈骨折空心加压螺钉内固定术后股骨头坏死的原因分析[J].中国骨与关节损伤杂志,2017,32(2):182-184.
[9]Song HK,Choi HJ,Yang KH.Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years[J].Journal of the Care of the Injured,2016,47(12):2743-2748.