作　　者： (智春升）; (邬波）; (金冶华）; (刘军）; (邢犇）;

机构地区： 辽宁中医药大学,沈阳110847

出　　处： 《中国骨与关节外科》 2017年第2期132-135,共4页

摘　　要： 背景:目前,关于青壮年股骨颈骨折的治疗还存在争议。目的:探讨应用直接前侧入路(direct anterior approach,DAA)切开复位空心钉内固定治疗青壮年股骨颈骨折的疗效。方法:回顾性分析2011年3月至2014年3月采用DAA入路切开复位空心钉内固定治疗并获随访的58例青壮年股骨颈骨折的患者资料。男32例,女26例;年龄18~60岁,平均38.4岁;均为闭合性骨折;受伤原因:车祸伤22例,高处坠落伤12例,重物砸伤10例,摔伤14例。受伤至入院时间2~88 h,平均10 h;受伤至手术时间1~8 d,平均3.6 d。所有患者均为GardenⅣ型骨折,且闭合复位治疗未成功。根据X线片结果判断骨折愈合及股骨头坏死情况,必要时行MRI检查。根据Harris评分对髋关节功能进行评估。结果:58例患者均获得随访,随访时间3~5年,平均3.3年;手术时间45~96 min,平均52 min。术后3个月开始部分负重,6个月后完全负重。术后完全负重时间6~8个月,平均6.5个月;骨折临床愈合时间3~6个月,平均3.6个月。术后即刻和3年在X线片上测量的患肢Garden复位指数比较,差异均无统计学意义。髋关节功能Harris评分为62~98分,平均90.3分。3例患者发生骨折不愈合,愈合率为94.8%。6例患者发生股骨头缺血性坏死,发生率10.3%。无一例出现感染。4例大腿外侧部麻木,是由股外侧皮神经损伤所致,术后3个月均基本恢复。术后3年Harris评分,优41例,良8例,一般6例,差3例,优良率为84.5%。结论:对于青壮年股骨颈骨折中闭合复位不成功的病例,采用DAA入路空心钉内固定可直视下完成骨折的复位、固定,手术操作简便,骨折愈合率高,股骨头坏死发生率低,疗效满意。 Background：The treatment of femoral neck fractures in young adults is still in dispute. Objective：To investigate the clinical outcome of open reduction and cannulated screw fixation via direct anterior approach （DAA） for femoral neck fractures in young adults. Methods：Clinical data of 58 young patients with femoral neck fractures treated by cannulated screw fixation via DAA approach from March 2011 to March 2014 were enrolled in this retrospective study. There were 32 males and 26 females aged from 18 to 60 years old （average 38.4 years old）. All of them suffered from closed fractures, which were caused by traffic accidents in 22 cases, by falling accident from high place in 12, by crashing object injury in 10 and by falling injury in 14. The average time was 10 h （range, 2-88 h） from injury to hospital admission and 3.6 d （range, 1-8 d） from injury to operation. All the injuries were type Ⅳ fracture by Garden classification and closed reduction failed. Healing of fractures and avascular necrosis of the femoral head were evaluated based on the X-ray results or MRI if necessary. The hip function was evaluated based on Harris joint function scores. Results：The average follow-up duration was 3.3 years （range, 3-5 years） in all the patients. The average operation time was 52 min （range, 45-56 min）. Partial weight-bearing began from 3 months postoperatively, and full weight-bearing could begin from 6 months postoperatively. The mean full weight-bearing time was 6.5 months （range, 6-8 months）. The fracture union time was 3.6 months （range 3-6 months）. No statistical difference was found in the Garden＇s alignment index when comparing the measuring results immediately and 3 years after surgery. The mean HSS score was 90.3 （ranging from 62 to 98）. Nonunion was noted in 3 cases during the fol-low-up period. The fracture healing rate was 94.8%. The avascular necrosis of the femoral head was noted in 6 cases （10.3%）. No infection occurred. Nervus cutaneus femoris lateralis

关 键 词： 股骨颈骨骨折 直接前方入路 骨折固定术 内 青壮年