微創(chuàng)空心加壓螺釘聯(lián)合內(nèi)側(cè)支撐板治療青壯年Garden,Ⅲ、Ⅳ型股骨頸骨折

　　[摘要] 目的 觀察應(yīng)用直接前側(cè)入路（DAA）切開復(fù)位空心加壓螺釘聯(lián)合內(nèi)側(cè)支撐板治療青壯年Garden Ⅲ、Ⅳ型股骨頸骨折的臨床效果。 方法 回顧性分析2014年11月～2015年9月在河南省洛陽正骨醫(yī)院就診并應(yīng)用DAA入路切開復(fù)位空心加壓螺釘聯(lián)合內(nèi)側(cè)支撐板治療并獲得完整隨訪的37例青壯年股骨頸骨折患者的臨床資料。隨訪觀察骨折愈合及并發(fā)癥情況，采用髖關(guān)節(jié)Harris評(píng)分評(píng)估患髖功能，采用Garden復(fù)位指數(shù)評(píng)價(jià)骨折復(fù)位情況。 結(jié)果 本研究37例患者均獲得2年以上隨訪，術(shù)后3～6個(gè)月均獲得骨性愈合，平均愈合時(shí)間為（4.40±0.96）個(gè)月，均未出現(xiàn)內(nèi)固定松動(dòng)及骨折再移位。1例患者于術(shù)后2年出現(xiàn)股骨頭壞死，行保守治療，髖關(guān)節(jié)活動(dòng)未受明顯影響；1例患者出現(xiàn)大腿外側(cè)皮膚感覺減退，考慮為股外側(cè)皮神經(jīng)損傷所致，給予藥物對(duì)癥治療，5個(gè)月后恢復(fù)。末次隨訪髖關(guān)節(jié)Harris評(píng)分為（89.66±4.52）分，術(shù)前評(píng)分為（40.41±6.98）分，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）。術(shù)后3 d和術(shù)后2年復(fù)查髖關(guān)節(jié)X線片測(cè)量的Garden復(fù)位指數(shù)比較，差異無統(tǒng)計(jì)學(xué)意義（P > 0.05）。 結(jié)論 運(yùn)用DAA入路切開復(fù)位空心加壓螺釘聯(lián)合內(nèi)側(cè)支撐板治療青壯年Garden Ⅲ、Ⅳ型股骨頸骨折，術(shù)中創(chuàng)傷小，復(fù)位準(zhǔn)確，內(nèi)固定牢靠，有利于患者術(shù)后早期活動(dòng)康復(fù)，降低骨折不愈合及股骨頭壞死的發(fā)生率，值得臨床推廣應(yīng)用。
　　[關(guān)鍵詞] 直接前側(cè)入路；內(nèi)側(cè)支撐板；空心加壓螺釘；青壯年；股骨頸骨折
　　[中圖分類號(hào)] R683.42 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1673-7210（2018）02（c）-0067-05
　　Minimally invasive with cannulated compression screw combined with medial support plate in young adults with Garden Ⅲ and Ⅳ femoral neck fractures
　　WEN Yangyang1 LYV Jing1 SUN Haui1 FAN Ya′nan1 LI Wenlong2 JIA Yudong2 LIU Youwen2
　　1.Luoyang Working Department for Postgraduate Education， He′nan University of Chinese Medicine， He′nan Province， Zhengzhou 450046， China； 2.the Second Department of Hip Injury， He′nan Luoyang Orthopedic Traumatological Hospital Orthopaedic Hospital of He"nan Province， He"nan Province， Luoyang 471002， China
　　[Abstract] Objective To observe the clinical effect of open reduction with cannulated compression screw combined with medial support plate via direct anterior approach （DAA） in the treatment of Garden Ⅲ and Ⅳ femoral neck fractures in young adults. Methods Clinical data of 37 young patients with femoral neck fractures treated by cannulated compression screw combined with medial support plate via DAA approach in He′nan Luoyang Orthopedic Traumatological Hospita from November 2014 to September 2015 were eolled in this retrospective study. Fracture healing and complications were followed up and observed. The hip function was evaluated by hip Harris score and the fracture reduction was evaluated by Garden reset index. Results In this study， 37 patients were followed up for more than 2 years. All patients achieved bone healing in 3-6 months after operation， the average healing time was （4.40±0.96） months. No loosening of internal fixation or displacement of fracture occurred. Two years after operation， one patient had osteonecrosis of the femoral head， then the conservative treatment was performed， the activity of the hip joint was not significantly affected. One patient experienced a decrease in sensation of the skin outside the thigh， which was considered to be caused by injury of the lateral femoral cutaneous nerve and was given the drug symptomatic treatment， and recovered after 5 months. The final follow-up of the Harris hip score was （89.66±4.52）， which was significantly higher than the preoperative score （40.41 ± 6.98） （P < 0.05）. There was no significant difference in the Garden reset index between 3 d after operation and 2 years after the operation （P > 0.05）. Conclusion By using open reduction with hollow compression screw combined with medial support plate via DAA approach in the treatment of Garden Ⅲ and Ⅳ femoral neck fracture in young adults， the injury is small， the reduction is accurate and the internal fixation is firm， which is beneficial to early active rehabilitation after operation and to reduce the incidence of nonunion and necrosis of the femoral head. It is worth popularizing in clinic.

相關(guān)熱詞搜索：股骨頸 青壯年 螺釘 加壓 空心