经皮改锥杆辅助闭合复位技术在外展嵌插型股骨颈骨折治疗中的应用  

Application of percutaneous screwdriver rod-assisted closed reduction in treatment of valgus-impacted femoral neck fractures

作　　者：王晓盼[1] 吴敏[1] 陈笑天[1] 叶龙飞 代秀松[1] WANG Xiaopan;WU Min;CHEN Xiaotian;YE Longfei;DAI Xiusong(Department of Orthopaedics,Anhui Key Laboratory of Tissue Transplantation,the First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui,233004,P.R.China)

机构地区：[1]蚌埠医学院第一附属医院创伤骨科组织移植安徽省重点实验室,安徽蚌埠233004

出　　处：《中国修复重建外科杂志》2023年第3期272-276,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨经皮改锥杆辅助闭合复位技术治疗外展嵌插型股骨颈骨折的可行性及疗效。方法2021年1月—2022年5月,采用经皮改锥杆辅助闭合复位、股骨颈动力交叉钉系统(femoral neck system,FNS)内固定治疗12例外展嵌插型股骨颈骨折患者。男6例,女6例;年龄21~63岁,中位年龄52.5岁。致伤原因:交通事故伤2例,摔伤9例,高处坠落伤1例。均为单侧闭合骨折,其中左侧7例、右侧5例。受伤至手术时间1~11 d,平均5.5 d。记录骨折愈合时间以及术后并发症发生情况,采用Garden指数评价骨折复位质量,Harris评分评价髋关节功能,观测股骨颈短缩情况。结果患者手术均顺利完成。术后1例切口出现脂肪液化,经加强换药后愈合;其余患者切口均Ⅰ期愈合。患者均获随访,随访时间6~18个月,平均11.7个月。X线片复查示,骨折复位质量根据Garden指数评价达Ⅰ级10例、Ⅱ级2例;骨折均达骨性愈合,愈合时间3~6个月,平均4.8个月;末次随访时股骨颈短缩1~4 mm,平均2.1 mm;随访期间无内固定失效、股骨头坏死发生。末次随访时,髋关节Harris评分85~96分,平均92.4分;获优10例,良2例。结论对于外展嵌插型股骨颈骨折,采用经皮改锥杆辅助闭合复位技术能有效解锁外展嵌插的股骨头,使股骨颈骨折达到良好复位,具有操作简单、有效以及对股骨头血供影响小等优点。Objective To evaluate the feasibility and effectiveness of percutaneous screwdriver rod-assisted closed reduction in the treatment of valgus-impacted femoral neck fractures.Methods Between January 2021 and May 2022,12 patients with the valgus-impacted femoral neck fractures were treated with percutaneous screwdriver rod-assisted closed reduction and femoral neck system(FNS)internal fixation.There were 6 males and 6 females with a median age of 52.5 years(range,21-63 years).The fractures were caused by traffic accident in 2 cases,falling in 9 cases,and falling from height place in 1 case.All were unilateral closed femoral neck fractures,including 7 on the left side and 5 on the right side.The time from injury to operation was 1-11 days,with an average of 5.5 days.The fracture healing time and postoperative complications were recorded.The quality of fracture reduction was evaluated by Garden index.At last follow-up,Harris score was used to evaluate the hip joint function,also the shortening of femoral neck was measured.Results All the operations were successfully completed.After operation,the incision fat liquefaction occurred in 1 case,which healed after enhanced dressing change,and the other patients’incisions healed by first intention.All patients were followed up 6-18 months,with an average of 11.7 months.The X-ray film reexamination showed that the quality of fracture reduction was gradeⅠin 10 cases and gradeⅡin 2 cases according to the Garden index.All fractures reached bony union,and the healing time was 3-6 months,with an average of 4.8 months.At last follow-up,the femoral neck was shortened by 1-4 mm,with an average of 2.1 mm.No internal fixation failure or osteonecrosis of the femoral head occurred during follow-up.At last follow-up,the hip Harris score was 85-96,with an average of 92.4;10 cases were rated as excellent and 2 were good.Conclusion The percutaneous screwdriver rod-assisted closed reduction can effectively reduce the valgus-impacted femoral neck fracture.It has the advantages of simple

关 键 词：外展嵌插型股骨颈骨折 改锥杆 股骨颈动力交叉钉系统 闭合复位 内固定 

分 类 号：R687.3[医药卫生—骨科学]