切开复位与闭合复位治疗移位型股骨颈骨折的疗效比较  

Open reduction versus closed reduction in treatment of femoral neck fractures

作　　者：勘武生[1] 郑琼[1] 胡家朗[1] 陈明[1] 王俊文[1] 程文俊[1] 徐敏超[1] 

机构地区：[1]华中科技大学同济医学院附属普爱医院骨科,武汉430033

出　　处：《中华创伤骨科杂志》2011年第5期401-405,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的 比较切开复位与闭合复位内固定治疗移位型股骨颈骨折（GardenⅢ、IV型）的疗效。方法回顾性分析1998年1月至2006年6月收治且获得完整随访的122例成人移位型股骨颈骨折患者资料，根据复位方式不同分为两组：闭合复位组73例，男42例，女31例；平均年龄（56．2±2．4）岁；骨折Garden分型：Ⅲ型43例，Ⅳ型30例。切开复位组49例，男30例，女19例；平均年龄（57．5±3．1）岁；骨折Garden分型：Ⅲ型27例，Ⅳ型22例。对比分析两组患者的骨折复位质量、内固定置人满意率、骨折不愈合发生率及股骨头缺血性坏死率。结果 122例患者术后获20～101个月（平均50．3个月）随访。闭合复位组骨折复位质量：I级39例，Ⅱ级19例，Ⅲ级或Ⅳ级15例；开放复位组I级38例，Ⅱ级9例，Ⅲ级或Ⅳ级2例，两组比较差异有统计学意义（X＾2=9．519，P=0．010）。两组患者术后内固定置人满意率分别为86．3％（63／73）、87．8％（43／49），骨折不愈合发生率分别为8．2％（6／73）、6．1％（3／49），两组比较差异均无统计学意义（P〉0．05）。切开复位组股骨头缺血性坏死率（10．2％）低于闭合复位组（27．4％），差异有统计学意义（X＾2=5．320，P=0．021）。结论 对于移位型股骨颈骨折，切开复位内固定并不会增加术后股骨头缺血性坏死的发生率。对闭合复位失效或骨折移位明显的患者，及时行切开复位内固定是非常有必要的。Objective To compare the clinical effects of open reduction and closed reduction in treatment of the displaced femoral neck fractures （Garden types Ⅲ and IV）. Methods The clinic data of 122 patients who had been treated for displaced femoral neck fractures in our hospital from January 1998 to June 2006 were included for the present respective analysis. Of them, 73 cases were treated with closed reduction and 49 with open reduction. In the closed reduction group, there were 42 men and 31 women （mean age, 56.2 _＋ 2.4 years）, and 43 cases of Garden Ill and 30 cases of Garden IV. In the open reduction group, there were 30 men and 19 women （mean age, 57.5 ＋- 3.1 years）, and 27 cases of Garden Ⅲ and 22 eases of Garden IV. The 2 groups were compared in reduction quality, satisfactory fixation, ratio of nonunion and ratio of femoral avascular necrosis. Results The 122 patients received a mean follow-up of 50.3 months （from 20 to 101 months）. The reduction quality was rated as grade I in 39 cases, as grade Ⅱin 19 cases, as grade m or Ⅲ and Ⅳ in 15 cases in the closed group, and as grade I in 38 cases, as grade Ⅱ in 9 cases, as grade Ⅲ or IV in 2 cases in the open group. The differences between the 2 groups were significant （X^2 = 9. 519, P = O. 010） . There were no significant differences between the 2 groups in satisfactory fixation （86.3% versus 87.8% ） or in nonunion ratio （8.2% versus 6. 1% ） （ P 〉 0.05） . The ratio of femoral avascular necrosis for the open reduction group （ 10.2% ） was significantly lower than that for the closed reduction group （27.4%） （X^2 = 5. 320, P = 0. 021 ）. Conclusion Since open reduction can lower the ratio of （emoral avascular necrosis for displaced femoral neck fractures, it is essential to perform timely open reduction when closed reduction fails or the fracture is obviously displaced.

关 键 词：股骨颈骨折 骨折固定术 内 股骨头缺血性坏死 复位 

分 类 号：R687.3[医药卫生—骨科学]