切开复位空心螺钉加内侧支撑钢板固定治疗PauwelsⅢ型股骨颈骨折的三年随访结果报道  

Treatment of PauwelsⅢfemoral neck fractures with open reduction and fixation with cannulated screws and an augmented plate:a 3-year follow-up report

作　　者：程国杰[1] 吕刚[1] 杨春[1] 王筠[1] 吴迎春[1] 孙辉[1] 徐向阳 Cheng Guojie;Lyu Gang;Yang Chun;Wang Yun;Wu Yingchun;Sun Hui;Xu Xiangyang(Department of Trauma and Orthopaedics,Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine,The Fourth Hospital Affiliated to Xinjiang Medical University,Urumqi 830000,China;Department of Orthopaedics,The Second Hospital Affiliated to Henan University of Traditional Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]新疆维吾尔自治区中医医院(新疆医科大学第四附属医院)创伤骨科,乌鲁木齐830000 [2]河南中医药大学第二附属医院骨科,郑州450000

出　　处：《中华创伤骨科杂志》2023年第12期1085-1089,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨切开复位空心螺钉加内侧支撑钢板固定PauwelsⅢ型股骨颈骨折的疗效及并发症发生情况。方法回顾性分析2015年1月至2018年10月期间新疆维吾尔自治区中医医院创伤骨科收治的8例新鲜PauwelsⅢ型股骨颈骨折患者资料。男7例,女1例;年龄(47.7±14.0)岁;Pauwels角为50°~70°者6例,>70°者2例。所有患者骨折闭合复位均不理想,行改良Smith-Petersen入路切开复位空心螺钉加内侧支撑钢板固定。记录患者术后1个月、6个月、1年、3年随访时的骨折愈合情况、髋关节Harris评分及并发症发生情况等。结果术后1个月:8例患者均获随访,髋关节Harris评分为(38.4±3.6)分;并发症:股骨颈短缩7例,切口脂肪液化1例。术后6个月:7例患者获随访,髋关节Harris评分为(70.6±2.8)分;1例患者解剖位愈合,4例患者短缩愈合,2例患者短缩延迟愈合。与术后1个月相比,股骨颈短缩、中空螺钉退钉、支撑钢板内螺钉松动程度均增加。术后1年:7例患者获随访,髋关节Harris评分为(85.5±4.4)分;与术后6个月相比,骨折愈合及并发症未发生明显变化。术后3年:1例前期失访患者于术后34个月因心脏病而死亡;1例患者于术后16个月出现骨折不愈合、空心螺钉切出,行全髋关节置换术;其余6例患者髋关节Harris评分为(93.6±2.5)分,其中5例患者股骨颈骨折获愈合,包括4例短缩愈合(1例并发股骨头缺血性坏死)和1例解剖位愈合,另1例患者骨折不愈合。结论切开复位空心螺钉加内侧支撑钢板固定PauwelsⅢ型股骨颈骨折的临床结果不理想,主要并发症为股骨颈短缩,3枚空心螺钉起固定作用,内侧支撑钢板的辅助作用不明显。Objective To observe the curative effects and complications of open reduction and fixation with cannulated screws and an augmented plate for Pauwels typeⅢfemoral neck fractures.Methods A retrospective study was conducted to analyze the data of 8 patients with fresh PauwelsⅢfemoral neck fracture who had been treated from January 2015 to October 2018 at Department of Trauma and Orthopaedics,Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine.There were 7 males and 1 female with an age of(47.7±14.0)years.The Pauwels angle ranged from 50°to 70°in 6 cases and was>70°in 2 cases.As the original closed reduction was not ideal in all the patients,open reduction via the modified Smith-Petersen approach and fixation with cannulated screws and an augmented plate were performed.Fracture healing,Harris hip score,and complications were followed up at 1 month,6 months,1 year,and 3 years postoperatively.Results At 1 month after operation:8 patients were followed up,their Harris hip score was(38.4±3.6)points,and there were 7 cases of femoral neck shortening and 1 case of incision fat liquefaction.At 6 months after operation:7 patients were followed up,their Harris hip score was(70.6±2.8)points,and 1 patient healed anatomically,4 patients healed with shortening,and 2 patients healed with delay and shortening.Femoral neck shortening,withdrawal of cannulated screws,and screw loosening within the augmented plate were all increased compared with 1 month after operation.At 1 year after operation:7 patients were followed up,their Harris hip score was(85.5±4.4)points,there were no significant changes in fracture healing or complications compared with 6 months after operation.At 3 years after operation:the patient lost to prior follow-up died of heart disease 34 months after operation,1 patient had to undergo total hip arthroplasty due to fracture nonunion and cutout of cannulated screws at 16 months after operation,and the other 6 patients had a Harris hip score of(93.6±2.5)points.Of the 6 patients,femora

关 键 词：股骨颈骨折 骨折固定术 内 骨板 骨钉 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]