摘要
目的探讨应用前方(DAA)入路切开骨折解剖复位应用内侧支撑钢板联合空心钉内固定治疗青壮年股骨颈骨折的临床疗效。方法29例青壮年股骨颈骨折DAA入路切开解剖复位股骨颈内侧放置支撑钢板联合外侧经皮三枚空心加压螺钉固定治疗此类型骨折。术后定期随访,末次使用Harris评分对髋关节功能进行评估。结果26例患者获得随访,随访时间18~24个月,平均21.6个月。手术时间73~96 min,平均82 min;术中失血量180~300 mL,平均220 mL;Garden对线指数:Ⅰ级复位16例,Ⅱ级复位10例。1例大腿外侧皮肤感觉麻木,系骨外侧皮神经损伤所致,术后半年恢复;骨折愈合时间12~24周,平均18.6周,末次随访内固定在位,Garden指数无明显变化;2例出现骨折不愈合;骨折愈合率92.31%,3例出现股骨头缺血性坏死,为股骨颈头下型,Garden分型Ⅳ型。疗效采用髋关节Harris评分标准:优15例,良8例,一般2例,差1例,优良率为88.46%。结论DAA入路骨折解剖复位股骨颈内侧支撑钢板联合外侧三枚空心加压螺钉固定有效,骨折愈合率高,股骨头坏死发生率低,髋关节功能恢复好,疗效满意,是一种治疗青壮年不稳定股骨颈骨折的有效方法。
Objective To investigate the effect of medial-buttress-plate augmentation of cannulated-screws fixation through direct anterior approach(DAA) for unstable femoral neck fracture in young adults.Methods 29 young patients with unstable femoral neck fractures were treated by open reduction under medial-buttress-plate and cannulated-screws fixation through DAA. The patients were regularly followed up after operation. The hip function was evaluated by Harris Joint Function scores.Results 26 patients were eventually completed the study. The average duration of follow-up was 21.6 months(18~24 months).The average time of operation was 82 min(73~96 min);Intraoperative blood loss was 180~300 mL,with an average of 220 mL;The reduction quality Garden index was determined in postoperation and there were 16 patients recovered to level I and 10 patients recovered to level II. The lateral cutaneus femoris nervu was damaged in one case, which resulted in leg numbness but recovered 6 months later. The time of fracture healing was 18.6 weeks(12~24 weeks);No statistical difference of the implants was found in the Garden’s alignment index when comparing the measuring results immediately and the last following-up time. Nonunion was noted in three cases during the follow-up period. The fracture healing rate was 92.31%. The avascular necrosis of the femoral head was noted in three cases and all cases were subcephalic and Garden Ⅳ fracture. The outcomes were excellent in 15 cases, good in 8,fair in 2,and poor in one case according to Harris Joint Function scores the last follow-up period after surgery, and the excellent and good rate was 88.46%.Conclusion Open reduction under direct vision and medial buttress plate and cannulated screws fixation through DAA treating unstable femoral neck fractures has a high rate of fracture healing and a low incidence of the avascular necrosis of the femoral head in young adults.In addition, the hip joint function is recovered well and the curative effect is satisfactory, which is an effective method
作者
陈小亮
马志荣
任磊
马建明
马锋
CHEN Xiaoliang;MA Zhirong;REN Lei;MA Jianming;MA Feng(Department of Orthopedics,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)
出处
《宁夏医学杂志》
CAS
2021年第3期214-216,I0001,共4页
Ningxia Medical Journal
