摘要
目的 探讨空心螺钉内固定治疗老年股骨颈骨折术后颈短缩的测量方法及其对髋关节功能的影响. 方法 回顾性分析2007年6月至201 3年10月期间采用闭合复位空心螺钉内固定治疗的214例老年股骨颈骨折患者资料,男71例,女143例;平均年龄为77.2岁;骨折Garden分型：Ⅰ、Ⅱ型（无移位）骨折65例,Ⅲ、Ⅳ型（有移位）骨折149例.将随访期间X线片与术后首次X线片比较观察是否存在空心螺钉尾端外露,以外露最长螺钉为测量标志,将钉杆外露长度作为颈短缩长度,并以此长度与钉帽厚度的比值对颈短缩进行分度：1度：颈短缩＜1个钉帽;2度：颈短缩在1～2个钉帽;3度：颈短缩＞2个钉帽.对颈短缩长度与患侧肢体短缩长度、患者髋关节Harris评分的关系进行相关性分析. 结果 共有78例患者发生颈短缩,发生率为36.4％ （78/214）,其中1度12例（15.4％）,2度24例（30.8％）,3度42例（53.8％）.颈短缩长度与患侧肢体短缩长度呈正相关（r=0.919,P=0.000）.术后12个月180例患者的髋关节Harris评分为32 ～98分,平均77.3分.颈短缩患者髋关节Harris评分较无颈短缩患者低,差异有统计学意义（t=9.904,P=0.000）;颈短缩长度与髋关节Harris评分呈负相关（r=-0.707,P=0.000） 结论 本研究所采用的颈短缩测量及分度方法较直观,便于临床应用;严重颈短缩对髋关节功能有影响.
Objective To explore the measurement of femoral neck shortening （FNS） after cannulated screwing for elderly femoral neck fractures and the effect of FNS on hip functional outcome.Methods Totally 214 elderly patients with femoral neck fracture were included in this study who had been treated by fixation with cannulated screws from June 2007 to October 2013.They were 71 males and 143 females,with an average age of 77.2 years.According to Garden classification system,65 cases were types Ⅰ and Ⅱ （undisplaced fractures）,and 149 types Ⅲ and Ⅳ （displaced fractures）.The postoperative X-ray and follow-up X-ray films were compared to observe whether the trailing end of screw shaft was exposed to the outer cortex of the proximal femur.We chose the screw which had the longest exposure of trailing end to measure the length of the exposed screw shaft as the length of FNS.FNS indexes were defined according to the ratio of the length of exposed screw shaft to the thickness of screw head.FNS degree 1：〈 1 screw head; FNS degree 2：1 to 2 screw heads; FNS degree 3：〉 2 screw heads.The relationships of the FNS length respectively with thefemur length decrease and Harris scores of hip functional outcome were analyzed statistically.Results FNS occurred in 78 cases,giving an incidence of FNS of 36.4% （78/214）.Of them,12 cases （15.4%）were defined as degree 1,24 cases （30.8%） as degree 2,and 42 cases （53.8%） as degree 3.There was a significant positive correlation between the FNS length and the femur length decrease（r =0.919,P =0.000）.The average Harris score at 12 months postoperation for 180 cases was 77.3 points （ranging from 32 to 98 points）.The average Harris score for those with FNS was significantly lower than that for those without FNS （t =9.904,P =0.000）.There was a significant negative correlation between the FNS length and Harris scores （r =-0.707,P =0.000）.Conclusions Our measurement of FNS and FNS indexes are easy to be used in clinic.Severe FNS can influence the function of hip joint.
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2014年第8期651-655,共5页
Chinese Journal of Orthopaedic Trauma
关键词
股骨颈骨折
骨折固定术
内
骨钉
老年人
短缩
Femoral neck fractures
Fracture fixation, internal
Bone nails
Aged
Shortening
