中青年Garden Ⅲ和Ⅳ型股骨颈骨折两种手术方法的对比研究  

Comparative study of two different surgical methods for the treatment of Garden Ⅲ and Ⅳ femoral neck fractures in young adults

作　　者：张栋 喻爱喜[1] 余国荣[1] 陶圣祥[1] 潘振宇[1] 漆白文[1] 肖卫东[1] 邓凯[1] 李宗焕[1] Zhang Dong;Yu Aixi;Yu Guorong;Tao Shengxiang;Pan Zhengyu;Qi Baiwen;Xiao Weidong;Deng Kai;Li Zonghuan(Department of Mierosurgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院显微骨科,武汉430071

出　　处：《中华显微外科杂志》2018年第5期428-432,共5页Chinese Journal of Microsurgery

基　　金：武汉市黄鹤英才项目（2014）

摘　　要：目的比较切开复位空心钉内固定联合带血管蒂骨瓣（观察组）与闭合复位空心钉内固定（对照组）治疗中青年Garden Ⅲ、Ⅳ型股骨颈骨折的临床疗效。方法对2004年1月至2013年12月收治的股骨颈骨折患者进行回顾性研究，其中得到长期随访的中青年Garden Ⅲ、Ⅳ型股骨颈骨折共417例。137例行切开复位3枚空心钉内固定联合带旋股内侧动脉深支大转子骨瓣转位术，280例行闭合复位3枚空心钉内固定治疗。结果本次研究随访时间5~12年，末次随访时观察组平均Harris评分（93.68±5.12）分，高于对照组的（92.53±6.12）分，但两组差异无统计学意义（P〉0.05）。观察组和对照组骨折不愈合率分别为0.7%和14.6%，股骨头缺血坏死率分别为6.6%和4.6%，股骨颈短缩发生率分别为8.8%和22.5%，两组间的差异均有统计学意义（P〈0.05）。结论采用开放复位空心钉内固定联合带旋股内侧动脉深支大转子骨瓣治疗中青年Garden Ⅲ、Ⅳ型股骨颈骨折远期疗效优于闭合复位空心钉内固定术。ObjectiveTo compare internal fixation with hallow compression screws combined vascularized bone graft （observation group） with only three hallow compression screws （control group） in young patients’ Garden Ⅲ and Ⅳ femoral neck fractures.MethodsThe patients with femoral neck fracture were treated from January, 2004 to December, 2013 were retrospectively reviewed. A total of 417 displaced femoral neck fractures in young and middleaged patients were long term followed-up. One hundred and thirty-seven patients were underwent open reduction and internal fixation with 3 hallow compression screws combined with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery; 280 patients were treated by closed reduction with 3 hallow compression screws.ResultsPatients had been followed-up for 5-12 years. At the last follow-up point, the Harris score of flap in observation group（93.68±5.12） were higher than that in control group（92.53±6.12）, while it was no statistical difference（P〉0.05）. It was 0.7% of nonunion incidence rate in the observation group, and incidence of avascular necrosis of femoral head was 6.6%, and incidence of femoral neck shortening was 8.8%. In the control group, incidence of avascular necrosis of femoral head was 14.6%, nonunion incidence rate was 4.6%, and incidence of femoral neck shortening was 22.5%. The differences between two groups was statistically significance（P〈0.05）.ConclusionThe open reduction and internal fixation which is hallow compression screws in combination with a greater trochanter bone graft supported by the profound branch of medial circumflex femoral artery is an optimal treatment for young adults with Garden Ⅲ and Ⅳ femoral neck fractures.

关 键 词：股骨颈骨折 GARDEN分型 内固定 骨移植 转位 

分 类 号：R687.3[医药卫生—骨科学]