经皮加压钢板固定治疗中青年移位型股骨颈骨折  

Treatment of displaced femoral neck fractures with percutaneous compression plate in young and middle-aged patients

作　　者：王松华[1] 刘璠[2] 查涛[1] 杨志刚[1] 

机构地区：[1]南通大学第三附属医院骨科,无锡214041 [2]南通大学附属医院骨科,226001

出　　处：《中华创伤骨科杂志》2016年第11期932-937,共6页Chinese Journal of Orthopaedic Trauma

基　　金：基金项目：国家自然科学基金（81171743）中国专利号：ZL201420004119.1

摘　　要：目的探讨经皮加压钢板（PCCP）固定治疗中青年移位型股骨颈骨折的手术技巧及临床疗效。方法回顾性分析2011年5月至2015年5月采用PCCP固定治疗的43例中青年移位型股骨颈骨折患者资料。男24例，女19例；年龄为21—55岁，平均38．2岁。骨折按GaMen分型：Ⅲ型29例，Ⅳ型14例；按Pauwels分型：Ⅱ型18例，Ⅲ型25例。通过手法复位或撬拨技术进行复位且采用自主研发的髋部骨折微创手术三维定位贴膜指导置钉。记录患者术后临床和影像学结果，末次随访时应用髋关节Harris评分标准评定患髋功能。结果38例患者手法闭合复位成功，5例患者手法复位失败后采用撬拨技术成功复位。本组患者的手术时间为35～60min，平均53．2min；术中显性失血量为20～80mL，平均65．3mL；术中透视次数为6—20次，平均11．8次；患者部分负重时间平均为22．5d（14～30d），完全负重时间平均为3．2个月（2．5—4．0个月）。43例患者术后获12。46个月（平均28．5个月）随访。本组患者的骨折愈合时间为3～7个月，平均4．3个月。末次随访时髋关节Harris评分为71～98分，平均92．7分；优26例，良15例，可2例，优良率为95．3％。2例患者发生股骨头缺血性坏死。随访期间无一例患者发生骨不连、内固定物松动及髋内翻畸形等并发症。结论PCCP固定治疗中青年移位型股骨颈骨折难度较大，借助一定的手术技巧可以简化手术，充分体现PCCP微创、固定牢靠、并发症发生率低等优点，治疗效果良好。Objective To explore the operative treatment of displaced femoral neck fractures with percutaneous compression plate （PCCP） in young and middle-aged patients. Methods Forty-three young and middle-aged patients with displaced femoral neck fracture were treated with PCCP from May 2011 to May 2015. They were 24 males and 19 females, aged from 21 to 55 years （mean, 38.2 years）. According to the Garden classification, 29 eases were type Ⅲ and 14 type Ⅳ. According to the Pauwels classification, 18 cases were type Ⅱ and 25 type Ⅲ. After reduction was conducted manually or using percutaneous joystick technique, nailing was carried out under the guidance of the three-dimensional position sticker which had been invented by ourselves for minimally invasive treatment of hip fractures. Clinical and radiographic outcomes were recorded after operation and postoperative hip function was evaluated using Harris score. Results Manual reduction succeeded in 38 cases and the other 5 cases experienced reduction by percutaneous joystick tech- nique after failure of manual reduction. For this series, the operation time ranged from 35 to 60 minutes （mean, 53.2 minutes）, explicit blood loss from 20 to 80 mL （mean, 65.3 mL）, frequency of X-ray exposure from 6 to 20 times （mean, 11.8 times） during operation, the partial weight-bearing time from 14 to 30 days （mean, 22. 5 days）, and the full weight-bearing time from 2. 5 to 4. 0 months （mean, 3.2 months）. The 43cases were followed up for 12 to 46 months （mean, 28.5 months）. Bone union was achieved in all after 3 to 7 months （mean, 4.3 months）. The Harris hip scores at the final follow-ups ranged from 71 to 98 points （mean, 92.7 points） . The excellent to good rate was 95.3%, with 26 excellent cases, 15 good ones and 2 fair ones. Two cases developed femoral avascular necrosis. No nonunion, implant failure or hip varus was observed during follow-ups. Conclusion Although it is difficult to treat displaced femoral neck fractures in young and middle

关 键 词：股骨颈骨折 骨折固定术 内 骨板 手术技术 

分 类 号：R687.32[医药卫生—骨科学]