年轻患者移位型股骨颈骨折复位方式的比较研究  

A comparative study between closed reduction and open reduction internal fixation for displaced femoral neck fracture in young patients

作　　者：曾永吉 廖莲梅 丁洪 

机构地区：[1]重庆北部新区第一人民医院骨科,重庆401121 [2]重庆北部新区第一人民医院重症医学科,重庆401121

出　　处：《中国现代医生》2016年第2期58-61,共4页China Modern Doctor

摘　　要：目的比较闭合复位与切开复位方式对于年轻患者移位型股骨颈骨折术后临床效果及并发症的影响。方法回顾自2010年1月~2014年6月于我科因移位型股骨颈骨折行手术治疗的年轻患者（18～50岁）共122例。根据复位方式分为闭合复位螺钉内固定组与切开复位螺钉内固定组,术后3个月、6个月、12个月随访,比较患髋功能（Harris评分）、VAS评分,及术后切口部位感染、骨折不愈合、股骨头缺血性坏死的发生率。结果闭合复位组62例,切开复位组60例,其中25例因闭合复位失败选择切开复位。GardenⅢ型76例（62%）,Ⅳ型46例（38%）。平均随访时间（15.8±4.1）个月,末次随访时,闭合复位组的平均Harris评分为（87.3±6.6）分,开放复位组为（84.0±7.2）分,差异无统计学意义（P=0.395）。末次随访时骨折部位、主动屈伸、外展髋关节活动及负重行走时VAS评分两组间无显著性差异。122例患者中,仅1例出现切口部位感染,其余切口均I甲愈合,组间差异无统计学意义。术后6个月随访时,闭合复位组2例（3.2%）骨折不愈合,1例（1.6%）发生骨折畸形愈合,总愈合率为95.2%;切开复位组有3例（5.0%）患者出现骨折不愈合,总愈合率为95.0%。术后1年随访时,闭合复位组有3例（4.8%）,切开复位组有4例（6.7%）出现股骨头缺血性坏死,组间差异无统计学意义。结论两种复位方式均取得较好临床疗效,术后骨折不愈合及股骨头缺血性坏死发生率无明显差异。临床中需根据患者的个体情况及手术医师的经验决定复位方式。Objective To compare the treatment outcomes of closed and open reduction in young patient with displaced femoral neck fracture. Methods A total of 122 patients aged from 18 to 50 years with displaced femoral neck fracture,from January 2010 to June 2014, were retrospectively included and analyzed, and divided into closed reduction with internal fixation（CRIF） group and open reduction and internal fixation（ORIF） group according to the different reduction way, and followed up at 3 months,6 months,and 12 months postoperatively. Harris score, VAS score, the frequency of surgical site infection,nonunion and osteonecrosis of femoral head（ONFH） were compared between the two groups. Results 62 patients were treated with closed reduction and 60 with open reduction. Of them,76 patients（62%）were Garden type Ⅲ, 46（38%） were type Ⅳ. The average follow-up time was（15.8±4.1） months. In CRIF group, the Harris score was（87.3±6.6）,（84±7.2） in ORIF group, and the difference was not statistically significant（P=0.395）.The VAS score was similar in two groups. Only 1 patient developed surgical site infection. Nonunion occurred in 2 patients（3.2%） in CRIF group and 3 patients（5.0%） in ORIF group at 6 months postoperatively. ONFH occurred in 3patients（4.8%） in CRIF group and 4 patients（6.7%） in ORIF group. The above index of two groups was not statistically significant（P 0.05）. Conclusion Both CRIF and ORIF are effective to treat the displaced femoral neck fracture in young patients. And the rate of postoperative nonunion and ONFH is low. We should choose the appropriate reduction method according to the condition of patients and surgeons＇ experience.

关 键 词：移位型股骨颈骨折 闭合复位内固定 切开复位内固定 

分 类 号：R687.3[医药卫生—骨科学]