切开与闭合复位空心钉内固定术对股骨颈骨折患者的影响  

Impact of open versus closed reduction hollow screw internal fixation on patients with femoral neck fractures

作　　者：雷博艺 魏聪聪 曹雪飞 Lei Boyi;Wei Congcong;Cao Xuefei(Department of Osteoarthritis and Sports Medicine,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China;Department of Hand Microscopic Ankle Surgery,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China)

机构地区：[1]陕西省核工业二一五医院骨关节及运动医学科,咸阳712000 [2]陕西省核工业二一五医院手显微足踝外科,咸阳712000

出　　处：《国际医药卫生导报》2024年第24期4226-4230,共5页International Medicine and Health Guidance News

基　　金：陕西省重点研发计划(2021SF-338)。

摘　　要：目的探究切开与闭合复位空心钉内固定术对股骨颈骨折患者的影响。方法选取2020年1月至2023年6月陕西省核工业二一五医院收治的138例股骨颈骨折患者,按手术方式分为切开组(68例)和闭合组(70例)。切开组中男36例,女32例,年龄(48.77±5.23)岁,骨折Garden分型:Ⅲ型38例,Ⅳ型30例;给予切开复位空心钉内固定术治疗。闭合组中男38例,女32例,年龄(48.69±5.32)岁,骨折Garden分型:Ⅲ型36例,Ⅳ型34例;给予闭合复位空心钉内固定术治疗。比较两组手术及骨折愈合情况,术后1、3、6个月的髋关节功能及视觉模拟评分法(VAS)评分,术前及术后6个月的生活质量及术后并发症。采用χ^(2)检验、t检验进行统计分析。结果切开组的手术时间、术中出血量、术中透视次数、骨折愈合时间分别为(75.17±8.11)min、(143.07±18.17)ml、(25.69±2.59)次、(3.83±0.33)个月,闭合组上述指标分别为(62.87±7.54)min、(87.26±11.33)ml、(55.74±6.17)次、(5.24±0.47)个月,差异均有统计学意义(均P<0.001)。术后3个月、6个月,切开组的髋关节功能Harris评分分别为(83.47±8.10)分、(86.91±9.31)分,闭合组分别为(79.27±8.37)分、(82.54±8.13)分,差异均有统计学意义(均P<0.05)。术后1个月,切开组的VAS评分高于闭合组[(2.84±0.44)分比(2.24±0.43)分](P<0.05)。术后6个月,切开组健康调查量表的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均高于闭合组(均P<0.05)。术后6个月期间,切开组的并发症发生率低于闭合组[1.5%(1/68)比10.0%(7/70)],差异有统计学意义(χ^(2)=4.595,P=0.032)。结论与闭合复位空心钉内固定术相比,切开复位空心钉内固定术治疗股骨颈骨折疗效更好,并发症少,但手术时间较长,术中出血量较多,术后短期疼痛加重。Objective To investigate the effects of open reduction with hollow screw internal fixation versus closed reduction with hollow screw internal fixation in patients with femoral neck fractures.Methods A total of 138 patients with femoral neck fractures admitted to No.215 Hospital of Shaanxi Nuclear Industry from January 2020 to June 2023 were selected and were divided into an open reduction group(68 cases)and a closed reduction group(70 cases)according to surgical methods.In the open reduction group,there were 36 males and 32 females,aged(48.77±5.23)years,and the Garden classification of fracture was type Ⅲ in 38 cases and type Ⅳ in 30 cases.In the closed reduction group,there were 38 males and 32 females,aged(48.69±5.32)years,and the Garden classification of fracture was type Ⅲ in 36 cases and type Ⅳ in 34 cases.The closed reduction group received closed reduction hollow screw internal fixation,while the open reduction group received open reduction hollow screw internal fixation.The conditions of surgery and fracture healing,hip function and Visual Analogue Scale(VAS)scores 1,3,and 6 months after surgery,quality of life before surgery and 6 months after surgery,and postoperative complications were compared between the two groups.χ^(2) test and t test were used.Results The surgery duration and intraoperative blood loss in the open reduction group were higher than those in the closed reduction group[(75.17±8.11)min vs.(62.87±7.54)min,(143.07±18.17)ml vs.(87.26±11.33)ml],and the intraoperative fluoroscopy uses and fracture healing time were lower than those in the closed reduction group[(25.69±2.59)times vs.(55.74±6.17)times,(3.83±0.33)months vs.(5.24±0.47)months],with statistically significant differences(all P<0.001).Three and 6 months after surgery,the Harris hip scores in the open reduction group were(83.47±8.10)and(86.91±9.31)points,which were higher than those in the closed reduction group[(79.27±8.37)and(82.54±8.13)points],with statistically significant differences(both P<0.05).One month

关 键 词：股骨颈骨折 切开复位空心钉内固定术 闭合复位空心钉内固定术 髋关节功能 

分 类 号：R687.3[医药卫生—骨科学]