经直接前方入路切开复位与闭合复位治疗股骨颈骨折的疗效对比  

Comparison on the treatment effect of femoral neck fracture between open reduction by DAA incision and closed reduction

作　　者：曾建伟[1] 曹飞 陈鑫[1] 李程[1] ZENG Jianwei;CAO Fei;CHEN Xin;LI Cheng(Department of Orthopaedics, Chengdu First People's Hospital, Chengdu 610041, China)

机构地区：[1]成都市第一人民医院骨科,四川成都610041

出　　处：《西部医学》2021年第8期1194-1198,共5页Medical Journal of West China

基　　金：四川省科技厅重点研发计划项目(2018SZ0223)。

摘　　要：目的比较经直接前方入路(DAA)切开复位与闭合复位经皮空心螺钉内固定治疗股骨颈骨折的临床疗效。方法回顾性分析2015年12月~2018年12月因股骨颈骨折在我院分别行切开复位(n=46)和闭合复位空心螺钉内固定(n=46)治疗的患者,统计患者基本资料,骨折Garden类型,从受伤到手术治疗时间,手术时间,术中出血量,术后Garden复位指数,术后1 d、术后3、6、12及24月患髋Harris功能评分,并统计术后骨折不愈合率及股骨头缺血坏死发生率;采用Spearman相关分析及Logistic多元回归分析,研究影响股骨颈骨折术后股骨头缺血坏死的因素。结果切开复位组术中出血量、手术时间大于闭合复位组,但术后Garden复位指数优于闭合复位组(均P<0.05);术后6、12月切开复位组患髋Harris功能评分优于闭合复位组(P<0.05);术后24月内切开复位组患者股骨头缺血坏死率显著低于闭合复位组(P=0.01);两组骨折不愈合率无统计学差异(P=0.06)。Spearman相关分析发现,股骨颈骨折Garden分型与股骨颈骨折术后股骨头缺血坏死发生率呈显著正相关(R=0.521,P<0.001),但Logistic多元回归分析未能发现影响股骨颈骨折术后股骨头坏死发生率的相关因素。结论DAA入路切开复位空心螺钉内固定治疗股骨颈骨折比闭合复位经皮空心螺钉内固定质量更佳,术后12月内患髋功能更好,术后24月内股骨头缺血坏死发生率更低。Objective To evaluate the effect of femoral neck fracture treated by open reduction with direct anterior approach(DAA)and closed reduction and fixed by cannulated screws.Methods From December 2015 to December 2018,46 patients with femoral neck fracture were treated with open reduction and 46 patients with closed reduction by cannulated screws.The age,sex,height,weight of patients,Garden type of the fracture,time from injury to operation,operation time were prospectively analyzed.The amount of bleeding,Garden reduction index,Harris functional score of hip on day one,3,6,12 and 24 months after operation were obseved.The nonunion rate of fracture and the incidence of avascular necrosis of femoral head(ANFH)were calculated.Spearman’s correlation analysis and Logistic multiple regression analysis were used to study the factors affecting ANFH after femoral neck fracture Results The amount of bleeding and operation time in open reduction group were greater than those in closed reduction group(P<0.05),but Garden reduction index in open reduction group was better than that in closed reduction group(P=0.04).The Harris score of hip in open reduction group was better than that in closed reduction group at 6 months and 12 months after operation(P<0.01;P=0.01).Within 24 months after surgery,rate of ANFH in the open reduction group was significantly lower than that in the closed reduction group(P=0.01),and there was no statistical difference in the nonunion rate between the two groups(P=0.06).Spearman correlation analysis showed that there was a significant positive correlation between Garden classification of femoral neck fracture and the incidence of femoral head necrosis after femoral neck fracture(R=0.521,P<0.001),but Logistic multiple regression analysis did not find relevant factors affecting the incidence of femoral head necrosis after femoral neck fracture.Conclusion The quality of open reduction and cannulated screw fixation via DAA approach is better than that of closed reduction and percutaneous minimally invasive

关 键 词：股骨颈骨折 直接前方入路 闭合复位 经皮空心螺钉内固定 

分 类 号：R681.8[医药卫生—骨科学]