DAA入路切开复位联合大粗隆抗剪切螺钉治疗难复型PauwelsⅢ型股骨颈骨折的效果  

Curative Effect of Open Reduction via DAA Combined with Greater Trochanter Anti-shear Screws in the Treatment of Unreducible Pauwels TypeⅢFemoral Neck Fracture

作　　者：杜贵强 刘文静 张伟 DU Guiqiang;LIU Wenjing;ZHANG Wei(Department of Hip Joint Surgery,Henan Luoyang Orthopedic Hospital(Henan Orthopedic Hospital),Zhengzhou 450000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院)髋关节外科,河南郑州450000

出　　处：《河南医学研究》2024年第14期2568-2572,共5页Henan Medical Research

摘　　要：目的分析直接前侧入路(DAA)切开复位联合大粗隆抗剪切螺钉治疗难复型pauwelsⅢ型股骨颈骨折的效果。方法回顾性分析2020年4月至2022年6月河南省洛阳正骨医院(河南省骨科医院)收治的60例难复型pauwelsⅢ型股骨颈骨折患者的临床资料,依据治疗方式将其分为观察组(32例,DAA入路切开复位联合大粗隆抗剪切螺钉治疗)、对照组(28例,闭合复位3枚全螺纹空心加压螺钉内固定治疗),比较两组手术一般情况、髋关节功能(Harris髋关节功能评分)、骨折复位质量(Garden指数)、骨代谢指标[Ⅰ型前胶原氨基端前肽(PⅠNP)、骨特异性碱性磷酸酶(BAP)、Ⅰ型胶原羧基端肽(β-CTX)]、疼痛度[麦吉尔疼痛量表(McGill)]、并发症发生率。结果观察组手术时间较对照组延长、切口长度长于对照组、术中出血量多于对照组(P<0.05);两组骨折愈合时间比较,差异无统计学意义(P>0.05)。两组术后3、6、12个月Harris评分均高于术前(P<0.05),且观察组术后6、12个月Harris评分高于对照组(P<0.05)。两组术后6、12个月Garden分级比较,差异无统计学意义(P>0.05)。两组术后1个月血清PⅠNP、BAP增加,β-CTX及McGill评分减少(P<0.05),但组间比较差异无统计学意义(P>0.05)。两组随访期间股骨头坏死发生率比较,差异无统计学意义(P>0.05)。结论对于难复型pauwelsⅢ型股骨颈骨折经DAA入路行切开复位联合大粗隆抗剪切螺钉治疗复位效果较好,虽然可能破坏血运,但不影响术后髋关节功能恢复,不增加并发症风险,值得在临床推广实践。Objective To analyze the curative effect of open reduction via direct anterior approach(DAA)combined with greater trochanteric anti-shear screws in the treatment of unreducible pauwels typeⅢfemoral neck fractures.Methods The clinical data of 60 patients with unreducible pauwels typeⅢfemoral neck fractures admitted to Henan Luoyang Orthopedic Hospital(Henan Orthopedic Hospital)from April 2020 to June 2022 were retrospectively analyzed.According to the treatment method,they were divided into observation group(32 cases,treated with open reduction via DAA combined with greater trochanter anti-shear screws)and control group(28 cases,treated with closed reduction with 3 full-threaded cannulated compression screws).The general conditions of surgery,hip function(Harris Hip function score),fracture reduction quality(Garden index),bone metabolism indexes[N-terminal propeptide of typeⅠprecollagen(PⅠNP),bone specific alkaline phosphatase(BAP),βC-terminal cross-linked telopeptides of typeⅠcollagen(β-CTX)],pain degree[McGill’s pain questionnaire(McGill)],and the incidence of complications were compared between the two groups.Results The operation time of the observation group was longer than that of the control group,the length of incision was longer than that of the control group,and the intraoperative blood loss was more than that of the control group(P<0.05).There was no significant difference in fracture healing time between the two groups(P>0.05).Harris scores of both groups at 3,6 and 12 months after surgery were higher than those before surgery(P<0.05).Harris scores of the observation group at 6 and 12 months after surgery were higher than those of the control group(P<0.05).There was no significant difference in Garden classification between the two groups at 6 or 12 months after surgery(P>0.05).Serum PINP and BAP in both groups increased whileβ-CTX and McGill scores decreased at 1 month after surgery(P<0.05),without statistical difference between groups(P>0.05).There was no difference in the incidence of

关 键 词：股骨颈骨折 直接前侧入路 大粗隆抗剪切螺钉 

分 类 号：R683[医药卫生—骨科学]