摘要
目的回顾性分析Pauwels 3型股骨颈骨折的手术疗效。方法 2011年1～11月手术治疗Pauwels 3型股骨颈骨折46例,采用空心螺钉（cannulated screws,CS）固定的35例,动力髋螺钉加空心螺钉（DHS＋CS）固定8例,近端股骨锁定加压钢板（locking compression plates,LCP）固定3例。根据Haidukewych标准评价复位质量,术后定期影像学检查观察骨折愈合和髋关节一般情况,分析骨折移位、断端粉碎、内固定方式与股骨颈骨不连和股骨头坏死发生的关系。结果 46例中,31例有完整的随访资料。1例DHS＋CS治疗的患者术后发生深部感染,经清创、抗感染治疗,术后6个月骨折畸形愈合后取出内固定。其它30例随访（20.1±5.9）个月,其中CS固定的22例,DHS＋CS固定5例,LCP固定3例。29例复位质量为优良,1例一般。8例出现股骨头坏死,2例骨不连,1例同时存在股骨头坏死和骨不连,19例骨折愈合且维持了良好的髋关节形态（63.3%）。不同的骨折移位、断端粉碎程度及内固定方式与股骨头坏死、骨不连的发生率之间,差异均无统计学意义。结论股骨头坏死和骨不连是Pauwels 3型股骨颈骨折术后常见的并发症,CS、DHS＋CS、LCP均可作为Pauwels 3型股骨颈骨折的治疗方案。骨折移位、断端粉碎和内固定方式对股骨头坏死、骨不连是否有影响,需要更大样本的病例验证。
Objective To retrospectively analyze the surgical treatment outcomes of Pauwels type-3 femoral neck fractures. Methods From January 2011 to November 2011, 46 patients with Pauwels type-3 femoral neck fractures were surgically treated. Cannulated screws（ CS） were used in 35 patients, dynamic hip screws plus CS（ DHS＋CS） in 8 patients and proximal femoral locking compression plates（ LCP） in 3 patients. Reduction quality was assessed according to Haidukewych criteria. Regular radiographic examinations were employed postoperatively to observe fracture healing and general condition of the hip joint. The association between fracture displacement, comminution and method of internal fixation and the incidence of femoral neck nonunion and osteonecrosis of the femoral head（ ONFH） were analyzed. Results Thirty-one of the 46 patients had intact follow-up data. Postoperative deep infections were noticed in 1 patient who was treated by DHS＋CS. And then the patient underwent debridement and anti-infective treatment. Hardware removal was performed following malunion at 6 months after the operation. The other 30 patients were followed up for（ 20.1±5.9） months. Fractures were stabilized by CS in 22 patients, by DHS＋CS in 5 patients and by LCP in 3 patients. In terms of reduction quality, 29 patients were graded as excellent, and while 1 patient was fair. ONFH was noticed in 8 patients and nonunion in 2 patients. One patient had ONFH and nonunion concomitantly. Good hip contour was preserved in 19 patients（ 63.3%）. There were no statistically significant differences regarding fracture displacement, comminution and method of internal fixation and the incidence of ONFH and nonunion. Conclusions ONFH and nonunion are common postoperative complications in the treatment of Pauwels type-3 femoral neck fractures. CS, DHS＋CS and LCP can be employed in the stabilization of Pauwels type-3 femoral neck fractures. However, the effects of fracture displacement, comminution and method of internal fixation on ONFH and nonunion are undefined, and a larger number of patients are desired for future study.
出处
《中国骨与关节杂志》
CAS
2015年第2期96-100,共5页
Chinese Journal of Bone and Joint
关键词
股骨颈
股骨骨折
外科手术
治疗结果
骨折
Femur neck
Femoral fractures
Surgical procedures
operative
Treatment outcome
Fractures
bone
