CT三维重建引导下双平面克氏针撬拨辅助复位与切开复位治疗股骨颈骨折的疗效比较  

Comparison Between Dual-plane Kirschner Wire Prying Assisted Reduction Guided by Three-dimensional CT Reconstruction and Open Reduction in the Treatment of Femoral Neck Fracture

作　　者：刘明宇 程子文 姚双权[1] 任栋[1] 耿林丹 康博洋 陈宇峰 王鹏程[1] Liu Mingyu;Cheng Ziwen;Yao Shuangquan(Trauma Emergency Center,The Third Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第三医院创伤急救中心,石家庄050000

出　　处：《中国微创外科杂志》2023年第6期456-461,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：河北医科大学第三医院2021年度老年病防治项目。

摘　　要：目的比较CT三维重建引导下双平面克氏针撬拨辅助复位与有限切开复位治疗难复性股骨颈骨折的临床疗效。方法回顾性分析2019年1月~2021年6月我院创伤急救中心采用CT三维重建引导下双平面克氏针撬拨辅助复位与有限切开复位治疗难复位性股骨颈骨折44例(GardenⅢ型19例和Ⅳ型25例),采用双平面克氏针撬拨辅助复位25例(撬拨复位组),切开复位19例(切开复位组),比较2组患者手术时间、术中出血量、术后复位质量、术后并发症情况。结果撬拨复位组手术时间(102.6±13.4)min,明显短于切开复位组(128.9±13.0)min(t=-6.546,P=0.000);术中出血量(66.7±11.5)ml,明显少于切开复位组(103.6±12.4)ml(t=-10.185,P=0.000)。撬拨复位组复位质量Ⅰ级20例,Ⅱ级5例,切开复位组Ⅰ级16例,Ⅱ级3例,2组复位质量差异无统计学意义(Z=-0.355,P=0.723)。44例平均随访2.1年(1.5~2.5年),骨折均愈合,撬拨复位组无术后并发症发生,切开复位组1例术后切口感染,1例随访1年后发生股骨头坏死。结论与切开复位相比,CT三维重建引导下双平面克氏针撬拨辅助复位治疗难复性股骨颈骨折,复位快捷,手术创伤小,是切开复位前值得尝试的方法。Objective To compare the clinical effect between dual-plane Kirschner wire prying assisted reduction guided by three-dimensional CT reconstruction and limited open reduction in the treatment of refractory femoral neck fracture.Methods From January 2019 to June 2021,44 patients with refractory femoral neck fracture in our hospital were retrospectively analyzed.There were 19 cases of Garden typeⅢand 25 cases of Garden typeⅣ.According to the intraoperative reduction method,the 44 cases were divided into prying reduction group(n=25)and open reduction group(n=19).The operation time,intraoperative bleeding volume,postoperative quality of reduction and postoperative complications were compared.Results The operation time in the prying reduction group[(102.6±13.4)min]was significantly less than that in the open reduction group[(128.9±13.0)min,t=-6.546,P=0.000],and the intraoperative bleeding volume in the prying reduction group[(66.7±11.5)ml]was significantly less than that in the open reduction group[(103.6±12.4)ml,t=-10.185,P=0.000].In the prying reduction group,the reduction quality was gadeⅠin 20 cases and gadeⅡin 5 cases;in the open reduction group,there were 16 cases of gradeⅠand 3 cases of gradeⅡ.The results showed no significant difference in reduction quality between the two groups(Z=-0.355,P=0.723).All the 44 cases were followed up for an average of 2.1 years(range,1.5-2.5 years).The fractures healed in all the 44 patients.No postoperative complications occurred in the prying reduction group.In the open reduction group,one patient had operative incision infection and one patient developed femoral head necrosis 1 year after surgery.Conclusion Compared to the limited open reduction,dual-plane Kirschner wire prying assisted reduction for the treatment of refractory femoral neck fracture guided by three-dimensional CT reconstruction has advantages of rapid reduction and less surgical trauma,which is worthy of trying before open reduction.

关 键 词：股骨颈骨折 克氏针 CT三维重建 切开复位 

分 类 号：R687.3[医药卫生—骨科学]