经直接前方入路大粗隆抗剪切螺钉治疗Pauwels Ⅲ型股骨颈骨折  

Great trochanter anti-shear screws through direct anterior approach for Pauwels type Ⅲ femoral neck fractures

作　　者：杨飞[1] 赵鹏[1] 姜佩瑜 YANG Fei;ZHAO Peng;JANG Pei-Yu(Department of Orthopedic Surgery, the Hospital of Yanqing District, Beijing 102100, China)

机构地区：[1]北京大学第三医院延庆医院北京市延庆区医院骨科,北京102100

出　　处：《中国矫形外科杂志》2018年第12期1079-1084,共6页Orthopedic Journal of China

摘　　要：[目的]探讨直接前方入路(DAA)切开复位联合大粗隆抗剪切螺钉治疗65岁以下PauwelsⅢ型股骨颈骨折的临床疗效。[方法]2014年1月~2016年3月本科治疗195例65岁以下股骨颈骨折患者,其中32例初次闭合复位Garden复位指数欠佳均为Pauwels分型Ⅲ型骨折[1],这32例患者均为闭合性骨折,男20例,女12例,年龄24~64岁,平均(49.17±13.62)岁。改用DAA切开复位大粗隆抗剪切螺钉内固定治疗。术后随访常规行X线片检查,判断股骨颈骨折愈合及股骨头坏死情况,必要时行CT及MRI检查进一步评价骨折愈合及股骨头血供情况,根据Harris评分[2]标准对髋关节功能进行评估。[结果]32例患者获得18~36个月,平均(27.69±6.16)个月随访,术后1.5~3个月,平均(2.39±0.56)个月复查X线片见骨痂形成,开始部分负重,6~9个月,平均(7.53±1.12)个月复查X线片见骨痂生长良好,可完全负重。髋关节功能Harris评分62~98分,平均(85.69±9.57)分,2例发生骨折不愈合,愈合率为93.75%,未发生股骨头缺血性坏死者,无1例出现感染。末次随访Harris评分,优24例,良4例,可2例,差2例,优良率为87.50%。[结论]对于65岁以下PauwelsⅢ型股骨颈骨折患者术中闭合复位欠佳,采用DAA联合大粗隆抗剪切螺钉内固定治疗临床疗效满意,可直视下复位骨折,手术操作简便,股骨头坏死发生率低。[Objective] To explore the clinical outcomes of open reduction and internal fixation with great trochanter antishear screws through direct anterior approach（DAA） for Pauwels type Ⅲ femoral neck fractures in patients younger than 65 years. [Methods] From January 2014 to March 2016, 195 patients aged less than 65 years were surgically treated in our department. Of them, 32 patients who had failed in the previous closed reduction with poor Garden reduction index were all classified as Pauwels type Ⅲ femoral neck fractures. There were 20 males and 12 females, aged from 24 to 64 years with an average of（49.17±13.62） years. All the 32 patients with closed fractures were changed to open reduction and internal fixation with great trochanter anti-shear screws through DAA. The postoperative follow-up was conducted by regular X-ray checks to assess bone healing and femoral head necrosis, If necessary, CT and MRI examinations were added to further evaluate the healing of fracture and femoral head blood supply, additionally, the assessment of hip function using Harris score. [Results] All the 32 patients were followed up for 18 to 36 months with an average of（27.69±6.16） months. The Harris score was from 62 to 98 with an average of（85.69±9.57）. Except 2 patients who were proved fracture nonunion, all the remaining patients got bony healing with healing rate of 93.8%. No avascular necrosis of the femoral head and no infection occurred in anyone of the patients. At the latest follow-up, the consequences based on Harris score were ranked as excellent in 24 patients, good in 4, fair in 2 and poor in 2, with an excellent rate of 87.5%. [Conclusion]Great trochanter anti-shear screws through DAA for Pauwels type Ⅲ femoral neck fracture in patients younger than 65 years who failed in previous closed reduction does get satisfactory outcomes with advantages of fracture reduction under direct vision,simplification of surgical manipulation and less avascular necrosis of the femoral head.

关 键 词：股骨颈骨折 直接前方入路 空心螺钉 内固定 

分 类 号：R683.42[医药卫生—骨科学]