动力髋螺钉联合股方肌蒂骨瓣移植治疗65岁以下股骨颈骨折  

Dynamic hip screw combined with quadratus femoris muscle pedicle bone flap transplantation in treatment of femoral neck fracture in patients under 65 years old

作　　者：杨杰 翁润民 雷广宇 程福宏 YANG Jie;WENG Run-mitt;LEI Guang-yu;CHENG Fu-hong(Department of Orthopaedics,Weinan Central Hospital,Weinan,Shaanxi 714000,China)

机构地区：[1]渭南市中心医院骨一科,陕西渭南714000

出　　处：《中国临床研究》2018年第10期1342-1346,共5页Chinese Journal of Clinical Research

基　　金：陕西省社会发展科技攻关项目(2014SF097)

摘　　要：目的对比动力髋螺钉联合股方肌蒂骨瓣移植和空心螺钉内固定法治疗65岁以下股骨颈骨折的临床效果。方法采用回顾性研究方法,选取2013年7月至2016年12月股骨颈骨折患者82例,采用空心螺钉内固定法治疗的41例为对照组,采用动力髋螺钉联合股方肌蒂骨瓣移植法治疗的41例为观察组。对比两组患者围术期指标;采用Harris评分对治疗后手术疗效进行评定,并对比两组治疗优良率;采用日常生活能力(ADL)评分表对患者日常生活能力进行评定;对比两组术后并发症发生情况。结果观察组手术切口长度、手术时间、术中出血量、骨折愈合时间、术后住院时间均高于对照组,差异有统计学意义(P均<0. 01);观察组Harris评分中疼痛、功能、畸形、活动度评分以及总分均高于对照组(P均<0. 01),治疗优良率亦高于对照组(80. 49%vs 51. 22%,P <0. 01);观察组术后1、6、12个月ADL量表总评分均高于对照组(P均<0. 01)。两组患者的内固定松动、股骨头坏死、骨折复发及切口感染发生率对比差异无统计学意义(P均> 0. 05),但并发症总发生率观察组低于对照组(7. 32%vs26. 83%,P <0. 05)。结论动力髋螺钉联合股方肌蒂骨瓣移植治疗65岁以下股骨颈骨折效果好于空心螺钉内固定法,能够明显改善患者Harris评分,提高术后日常生活能力,降低并发生症发生率。Objective To compare the clinical effect of dynamic hip screw combined with quadratus femoris muscle pedicle bone flap transplantation versus hollow screw fixation in the treatment of femoral neck fracture in patients under 65 years old. Methods Using a retrospective study method,82 patients with femoral neck fracture treated from July 2013 to December 2016 were selected and were divided into control group and observation group according to different surgical methods（n = 41,each）. The hollow screw internal fixation was conducted in control group,and dynamic hip screw combined with quadratus femoris muscle pedicle bone flap transplantation was conducted in observation group. Between two groups,the perioperative indexes were compared; Harris score was used to evaluate the curative effect of operation; the ability of daily life（ADL） score was used to evaluate the ability of daily life of patients; the incidence of postoperative complications was compared. Results The operative incision,operation time,intraoperative blood loss,fracture healing time and postoperative hospital stay in observation group statistically increased compared with control group（all P〈0.01）. Harris scores in pain,function,deformity,mobility,total score and the excellent rate（80. 49% vs 51. 22%） in observation group were significantly higher than those in control group（all P〈0.01）. The total scores of ADL at 1-,6-and12-month after operation in observation group were statistically higher than those in control group（all P〈0.01）. There were no statistical differences in internal fixation loosening,femoral head necrosis,fracture recurrence and incision infection between two groups（all P〈0.05）,but the total incidence of complications in observation group was significantly lower than that in control group（7. 32% vs 26. 83%,P〈0.05）. Conclusion Dynamic hip screws combined with quadratus femoris muscle pedicle bone flap transplantation is superior to the hollow screw internal fixation method and can obviously imp

关 键 词：股骨颈骨折 动力髋螺钉 骨瓣移植术 空心螺钉 Harris评分 日常生活能力量表 

分 类 号：R683.42[医药卫生—骨科学]