将空心钉作为导向器在股骨颈骨折闭合复位空心钉内固定术中的应用效果观察  

Effect of use of cannulated screw as guide apparatus in closed reduction and internal fixation of cannulated screws for femoral neck fractures

作　　者：陈耀东[1] 魏建军[1] 方勤[1] 甘伟伟 杨家赵 周骏武 CHEN Yao-dong;WEI Jian-jun;FANG Qin;GAN Wei-wei;YANG Jia-zhao;ZHOU Jun-wu(不详;Department of Orthopedics,the People’s Hospital of Chizhou,Chizhou,Anhui 247000,China)

机构地区：[1]池州市人民医院骨科,安徽247000 [2]中国科学技术大学第一附属医院创伤骨科,安徽合肥230001

出　　处：《中国骨与关节损伤杂志》2022年第12期1233-1237,共5页Chinese Journal of Bone and Joint Injury

基　　金：安徽省自然科学基金(1908085QH359)。

摘　　要：目的探讨将空心钉作为导向器在股骨颈骨折闭合复位空心钉内固定术中应用效果,评估其临床应用价值。方法观察组纳入自2018-05—2020-10用空心钉作为导向器行闭合复位空心钉内固定治疗19例股骨颈骨折,纳入同期未使用空心钉作为导向器而常规完成手术的18例股骨颈骨折作为对照组。比较两组手术时间、术中出血量、置钉过程中X线透视次数、骨折复位质量、并发症发生率,以及末次随访时髋关节功能Harris评分。结果37例均获得随访,随访时间平均11.1(8~18)个月。与对照组比较,观察组手术时间缩短,术中出血量减少,置钉过程中X线透视次数减少,差异有统计学意义(P<0.05)。观察组1例术后发生股骨头缺血性坏死,对照组术后出现3例股骨头缺血性坏死和1例内固定松动;观察组与对照组股骨头缺血性坏死发生率、内固定松动发生率差异无统计学意义(P>0.05)。观察组骨折复位质量、末次随访时髋关节功能Harris评分结果差异无统计学意义(P>0.05)。结论股骨颈骨折闭合复位空心钉内固定术中出现导针置入位置不佳时,将空心钉作为导向器可以在不改变进针点的情况下重新置入导针,有利于减少术中出血、缩短手术时间、减少术中放射性损伤,具有良好的临床应用价值。Objective To investigate the effect of use of cannulated screw as guide apparatus in closed reduction and internal fixation for femoral neck fractures,and evaluate its clinical value.Methods Nineteen cases of femoral neck fractures in observed group underwent closed reduction and internal fixation with the use of cannulated screw as guide apparatus from May2018 to October 2020 while 18 cases in control group were treated by closed reduction and internal fixation without guide apparatus in the same period.The operative time,intraoperative bleeding,intraoperative x-ray perspective times,effect of reduction,rate of complications and the Harris score at the last follow-up were compared between the two groups.Results The followups were completed in 37 cases and the mean follow-up period was 11.1(8-18)months.The observed group showed advantages in the operative time,intraoperative bleeding and intraoperative x-ray perspective times.The differences were significant(P<0.05).The avascular necrosis of femoral head(ANFH)occurred in 1 case in observed group,while the ANFH and the loosening of internal fixation occurred in 3 cases and 1 case in control group respectively.There were no significant differences in occurrence rates of ANFH and loosening of internal fixation(P>0.05).There were no significant differences of the effect of reduction and the Harris score at the last follow-up between two groups(P>0.05).Conclusion In closed reduction and internal fixation of cannulated screws for femoral neck fractures,the use of cannulated screw as guide apparatus is helpful for re-inserting the needle without changing entry point when the needle position is dissatisfactory,so as to reduce intraoperative bleeding,operative time,and radiation injury,which shows good clinical value.

关 键 词：股骨颈骨折 闭合复位 内固定 空心钉 导向器 

分 类 号：R687.3[医药卫生—骨科学]