高选择血管造影与Garden分型预测C臂指导下行闭合空心钉置入固定股骨颈骨折治疗效果的比较  

Cannulated screw fixation under C-arm guidance using digital subtraction angiography and Garden typing:Therapeutic effect of femoral neck fracture

作　　者：刘洋[1] 陈方舟[1] 郑先念[1] 袁希[2] 张建章[1] 夏述琳[2] 蔡林[3] 

机构地区：[1]武汉市第五医院(江汉大学附属第二医院)骨科,湖北省武汉市430050 [2]武汉市第五医院(江汉大学附属第二医院)放射科,湖北省武汉市430050 [3]武汉大学中南医院骨科,湖北省武汉市430071

出　　处：《中国组织工程研究与临床康复》2009年第35期6951-6954,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：湖北省武汉市卫生局科研基金资助(WX08D24)~~

摘　　要：目的:比较高选择血管造影与Garden分型预测以C臂指导完成闭合空心钉置入固定的股骨颈骨折治疗效果的准确性。方法:选择2004-03/2009-01湖北省武汉市第五医院(江汉大学附属第二医院)骨科和武汉大学中南医院骨科收治的成人单侧股骨颈骨折50例,男32例,女18例。根据患者意愿采用高选择血管造影与Garden分型各25例,比较两组空心钉置入内固定治疗后股骨头坏死的发生率。结果:两组患者术后随访最短个6月,最长60个月。DSA组Ⅰ型5例,Ⅱ型6例,Ⅲ型14例;Garden组Ⅰ型4例,Ⅱ型8例,Ⅲ、Ⅳ型13例。DSA组Ⅰ、Ⅱ型无股骨头坏死,Ⅲ型股骨头坏死14例;Garden组Ⅰ型无股骨头坏死,Ⅱ型股骨头坏死1例,Ⅲ、Ⅳ型股骨头坏死13例。两组比较差异无显著性意义(P>0.05)。结论:高选择血管造影显示血管的多少与Garden分型基本一致,但它能直观地了解股骨头的血供情况,可以根据残存支持带血管的多少来判断各型股骨颈骨折治疗后的效果及预后。OBJECTIVE： To compare the accuracy to cannulated screw fixation for treating femoral neck fracture using digital subtraction angiography （DSA） and Garden typing under C-arm guidance. METHODS： A total of 50 patients （32 males and 18 females） with lateral femoral neck fracture were collected from the Departments of Orthopedics, the Fifth Hospital of Wuhan City and Zhongnan Hospital of Wuhan University from March 2004 to January 2009. Every 25 patients were treated DSA and Garden typing under C-arm guidance, respectively, and incidence of femoral head necrosis following cannulated screw internal fixation was then compared between the two groups. RESULTS： Following up was lasted for 6-60 months. In the DSA group, 5 patients had type I fracture, 6 had type II, and 14 had type III; additional, in the Garden group, 4 patients had type I fracture, 8 had type II, and 13 had type III and type IV. Type I and type II femoral head necrosis was not detected in the DSA group, but type III one occurred in 14 patients. Moreover, type I femoral head necrosis was not found in the Garden group, but type II one occurred in one patient and type III and type IV occurred in 13 patients. There was no significant difference between the two groups （P 〉 0.05）. CONCLUSION： DSA shows that there is similar vascular numbers to Garden typing; however, DSA directly reflects blood supply of femoral head and determines therapeutic effect and prognosis of femoral neck fracture according to numbers of residual retinaculum vessels.

关 键 词：股骨颈骨折 GARDEN分型 高选择血管造影 

分 类 号：R683[医药卫生—骨科学]