应用闭合复位中空拉力螺钉植入技术治疗青壮年股骨颈骨折的特点  

Characteristics of closed reduction and internal fixation with cannulated lag screws for femoral neck fracture in youth and middle-aged persons

作　　者：聂飞[1] 杨天府[1] 池雷霆[1] 方跃[1] 刘绍江[1] 李元城[1] 

机构地区：[1]四川大学华西医院骨科,四川省成都市610041

出　　处：《中国组织工程研究与临床康复》2007年第16期3166-3167,共2页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：四川大学华西医院骨科于2000-01/2005-09对62例青壮年股骨颈骨折患者采用闭合复位中空拉力螺钉植入技术治疗。中空拉力螺纹钉螺纹直径6.5mm,中心孔直径2.1mm,钛合金材料。患者仰卧于下肢牵引床上,采用Mc Elvenny法或者Lead Bener法并结合本科自行总结的抖动法进行复位。C型臂透视证实复位成功后将患肢维持于轻度外展内旋位,克氏针定位空心钉进钉点,骨折断端对位对线以及克氏针位置良好后沿克氏针分别拧入3枚中空拉力螺钉至股骨头软骨下0.5cm,螺纹远端应全部位于近侧骨折段。术后平均随访20个月,骨折不愈合者5例,GardenⅢ型者3例,Garden Ⅳ型者2例,头下型者3例,头颈型者1例,经颈型者1例。术后19例发生不同程度股骨头缺血坏死,GardenⅠ型1例,GardenⅡ型3例,Garden Ⅲ型者9例,Garden Ⅳ型者6例,头下型者6例,头颈型者7例,经颈型者5例,基底型者1例。术后伤口均Ⅰ期愈合,无肺部感染,泌尿系统感染,深静脉血栓形成及压疮等并发症发生。应用中空拉力螺钉植入治疗股骨颈骨折,有利于维护骨折的稳定性,避免了骨折端分离,而且对骨折断端产生持续加压作用,产生压应力刺激成骨,促进骨折愈合。Totally 62 young and middle-aged patients with femoral neck fracture were treated with close reduction and internal fixation with cannulated lag screws at Department of Orthopaedics, West China Hospital, Sichuan University from January 2000 to September 2005. The lag screw was made of titanium alloy, Its diameter was 6.5 mm and diameter of bore center was 2.1 mm, The patients lied on the back on lower limb traction bed, Reduction was performed by Mc EIvenny method and Lead Bener method combined with self-designed buffeting method. C-arm fluoroscopy verified that after successful reduction, affected limb was put in mild abduction, and Kirschner wire located at hollow nail; after keeping the paratope and alignment of broken ends of fracture and good position of Kirschner wire, 3 cannulated lag screws were wrung 0.5 cm under cartilage of femoral head along Kirschner wire. Distal fillet should locate at proximal fracture segment. The average follow up was 20 months after operation. There were 5 cases of disunion fraction, 3 cases of Garden Ⅲ type, 2 cases of Garden Ⅳ type, 3 cases of sub-head type, 1 case of head-neck type and 1 case of via-neck type. Nineteen patients had ischemic necrosis of femoral head to different degrees after operation, 1 case of Garden Ⅰ type, 3 cases of Garden Ⅱ type, 9 cases of Garden Ⅲ type, 6 cases of Garden Ⅳ type, 6 cases of sub-head type, 7 cases of head-neck type, 5 cases of via-neck type and 1 case of basal-neck type. Wound was healing in Ⅰ phase after operation, no complication such as pulmonary infection, urinary system infection, deep venous thrombosis or pressure ulcer. Close reduction and internal fixation with cannulated lag screws for femoral neck fracture has the advantages on protecting stable fixation and avoiding separation of fraction point, and keeping pressure on fraction point, which will induce compressive stress to stimulate bone formation and accelerate fraction healing.

关 键 词：青壮年股骨颈骨折 中空拉力螺钉 内固定 

分 类 号：R681.8[医药卫生—骨科学]