髋关节镜辅助下复位联合空心钉内固定治疗青壮年移位型股骨颈骨折  

Hip arthroscopy assisted reduction and cannulated screw fixation for displaced femoral neck fractures in young adults

作　　者：张施展[1] 张卫国[1] 汪阳[1] 陈丰[1] 杜非 ZHANG Shi-zhan;ZHANG Wei-guo;WANG Yang;CHEN Feng;DU Fei(Department of Orthopaedics,the Central Hospital of Wuhan,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院骨科,武汉430014

出　　处：《骨科》2018年第4期296-301,共6页ORTHOPAEDICS

基　　金：武汉市卫生和计划生育委员会资助项目(WX17D07)

摘　　要：目的探讨髋关节镜辅助下复位联合空心钉内固定治疗青壮年移位型股骨颈骨折的临床效果。方法 2011年3月至2016年2月我科采用髋关节镜辅助复位治疗43例青壮年移位型股骨颈骨折病人,男25例,女18例;年龄为21～47岁,平均年龄为38.5岁;GardenⅢ型26例,Ⅳ型17例。采用Garden指数评估骨折复位质量,髋关节Harris评分(hip Harris score,HHS)评估患髋功能,疼痛视觉模拟量表(visual analogue scale,VAS)评估患髋疼痛情况。结果病例均获得随访,随访时间为(40±3)个月(21～80个月)。2例病人出现轻微退钉现象,均无骨折不愈合、复位丢失、髋内翻、内固定断裂等并发症发生。末次随访时均无骨折复位丢失,Garden指数Ⅰ级38例,Ⅱ级4例,Ⅲ级1例,优良率为97.7%;术后18个月的Harris髋关节评分,优29例,良10例,中3例,差1例,优良率为90.7%。术后18个月的Harris评分为(89.63±5.22)分,较术前的(53.42±6.71)分明显提高;VAS评分为(2.37±1.24)分,较术前的(7.85±1.33)分明显降低,差异均有统计学意义(P均<0.05)。4例GardenⅣ型骨折病人出现股骨头坏死,复位质量采用Garden指数评估:Ⅰ级1例,Ⅱ级2例,Ⅲ级1例;股骨头坏死发生时间为术后1.3～3.8年,平均1.8年。结论采用髋关节镜辅助复位联合内固定治疗青壮年移位型股骨颈骨折,手术创伤小,骨折复位满意,术后髋关节功能恢复良好,且能早期发现并处理关节内合并损伤,是一种安全可行的微创治疗方法。Objective To investigate the clinical outcomes of hip arthroscopy assisted reduction and cannulated screw fixation for the treatment of displaced femoral neck fractures in young adults.Methods Forty-three patients with displaced femoral neck fractures were treated with hip arthroscopy assisted reduction and cannulated screw internal fixation from March 2011 to February 2016.There were 25 males and 18 females,with an average age of 38.5 years(range from 21 to 47 years).According to Garden classification,there were 26 cases of typeⅢ,and 17 cases of typeⅣ.The fracture reduction quality was evaluated by Garden index.The hip function was evaluated by Harris hip score system.The hip pain was evaluated by VAS.Results All patients were followed up from 21-80 months(mean 40±3 months)in the outpatient department.Two cases presented with a small extent of screw extraction.All cases healed without complications of non-union,reduction lost,varus deformity of the hip,and breakage of the internal fixation.The fracture reduction quality at the 2nd day post-operation and the last follow-up X-ray films were evaluated according to Garden index.There was no reduction lost at the last follow-up with 38 excellent cases,4 good cases,and 1 fair case with the excellent and good rate being 97.7%.According to Harris hip score,there were 29 excellent cases,10 good cases,3 fair cases and 1 poor case at 18th month after operation with the excellent and good rate being 90.7%.The Harris hip score and VAS score were 89.63±5.22 and 2.37±1.24 respectively at 18th month after operation,which were statistically different from 53.42±6.71 and 7.85±1.33 pre-operation(P<0.05).Four cases presented with femoral head necrosis after the operation(from 1.3 to 3.8 years,average 1.8 years),with reduction quality of 1 excellent case,2 good cases and 1 fair case.Conclusion The treatment of displaced femoral fractures with hip arthroscopy assisted reduction and cannulated screw fixation is a minimal-invasive operation,which provides satisfactory fracture

关 键 词：股骨颈骨折 移位 髋关节镜 内固定 

分 类 号：R687.3[医药卫生—骨科学]