中国修复重建外科杂志

中国修复重建外科杂志

螺钉 F 形固定技术治疗 Pauwels Ⅲ型股骨颈骨折

查看全文

目的 探讨螺钉 F 形固定技术治疗 Pauwels Ⅲ型股骨颈骨折的临床疗效。 方法 2013 年 1 月—2016 年 12 月,采用螺钉 F 形固定技术治疗 Pauwels Ⅲ型股骨颈骨折 43 例。其中男 32 例,女 11 例;年龄 20~55 岁,平均 38.9 岁。左侧 21 例,右侧 22 例。致伤原因:交通事故伤 19 例,高处坠落伤 24 例。Garden Ⅲ型 25 例、Ⅳ型 18 例。受伤至手术时间 2~3 d,平均 2.2 d。记录手术时间、术中透视时间、术后住院时间、骨折复位质量、术后并发症(骨折不愈合、内翻畸形、股骨颈短缩、股骨头缺血性坏死、螺钉退出等)发生情况,采用 Harris 评分评价髋关节功能。 结果 手术时间 28~45 min,平均 37.5 min;术中透视时间 13~20 s,平均 14.7 s;术后住院时间 2~3 d,平均 2.7 d。患者切口均Ⅰ期愈合。43 例患者均获随访,随访时间 18~58 个月,平均 38.7 个月。X 线片显示,骨折均获解剖复位;42 例骨折愈合,愈合时间 3~5 个月,平均 3.6 个月;1 例闭合复位者骨折不愈合,行人工全髋关节置换术。末次随访时,髋关节 Harris 评分为 55~100 分,平均 92.7 分。42 例骨折愈合患者中发生股骨颈短缩 11 例、内翻畸形 9 例、股骨头缺血性坏死 3 例、螺钉退出 8 例。Garden Ⅲ、Ⅳ型患者相关并发症发生情况比较,差异无统计学意义(P>0.05)。 结论 采用螺钉 F 形固定技术治疗股骨颈骨折,临床疗效满意,术后并发症发生率较低。

Objective To summarize the effectiveness of F-shaped screw fixation technique in treatment of Pauwels type Ⅲ femoral neck fractures. Methods Between January 2013 and December 2016, 43 patients with Pauwels type Ⅲ femoral neck fractures were treated with F-shaped screw fixation technique. There were 32 males and 11 females with an average age of 38.9 years (range, 20-55 years). The fractures located on the left side in 21 patients and on the right side in 22 patients. The cause of injury included traffic accident in 19 patients and falling from height in 24 patients. There were 25 patients of Garden type Ⅲ and 18 of Garden type Ⅳ. The time from injury to operation was 2-3 days (mean, 2.2 days). These data were recorded, including operative time, fluoroscopy time, postoperative hospital stay, quality of reduction, postoperative complications (nonunion, varus deformity, femoral neck shortening, avascular necrosis of femoral head, screws back-out), and Harris scores. Results The operative time was 28-45 minutes (mean, 37.5 minutes). The fluoroscopy time was 13-20 seconds (mean, 14.7 seconds). The postoperative hospital stay was 2-3 days (mean, 2.7 days). All incisions healed by first intention. All patients were followed up 18–58 months with an average of 38.7 months. All patients have anatomical reduction of fractures. Fracture healing occurred in 42 patients; the union time was 3-5 months with an average of 3.6 months. Nonunion occurred in 1 patient who was treated with total hip arthroplasty. Of the 42 patients with fracture healing, 11 cases had a femoral neck shortening, 9 cases had varus deformity, 3 cases had avascular necrosis of femoral head, and 8 cases had screws back-out. There was no significant difference in complication incidences between Garden type Ⅲ fractures and Garden type Ⅳ fractures (P>0.05). Conclusion Treatment of femoral neck fractures by using the F-shaped screw fixation technique, can achieve satisfactory effectiveness with less postoperative complication.

关键词: 股骨颈骨折; 螺钉; 内固定; F 形固定技术

Key words: Femoral neck fracture; screw; internal fixation; F-shaped screw fixation technique

引用本文: 王峰, 刘瑜, 张长城. 螺钉 F 形固定技术治疗 Pauwels Ⅲ型股骨颈骨折. 中国修复重建外科杂志, 2018, 32(11): 1417-1420. doi: 10.7507/1002-1892.201805111 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 刘志荣, 葛云林, 丁舒晨, 等. 多轴锁定钢板内固定治疗中老年股骨颈骨折的近期疗效观察. 中国修复重建外科杂志, 2017, 31(1): 5-10.
2. 龙亚周, 张树明, 王奎友, 等. 股骨颈骨折空心钉固定闭合复位治疗策略. 中国修复重建外科杂志, 2016, 30(7): 809-814.
3. Papanastassiou ID, Mavrogenis AF, Kokkalis ZT, et al. Fixation of femoral neck fractures using divergent versus parallel cannulated screws. J Long Term Effort Med Implants, 2011, 21(1): 63-69.
4. Weil YA, Khoury A, Zuaiter I, et al. Femoral neck shortening and varus collapse after navigated fixation of intracapsular femoral neck fractures. J Orthop Trauma, 2012, 26(1): 19-23.
5. Filipov O. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Traumatol, 2011, 21(7): 539-543.
6. Tai TW, Lien FC, Lee PY, et al. Using a cannulated screw as a drill guide and sleeve: a simple technique for multiple-screw fixation for intracapsular femoral neck fracture. Orthopedics, 2010, 33(8): 549.
7. Sprague S, Schemitsch EH, Swiontkowski M, et al. Factors associated with revision surgery after internal fixation of hip fractures. J Orthop Trauma, 2018, 32(5): 223-230.
8. Ma JX, Kuang MJ, Xing F, et al. Sliding hip screw versus cannulated cancellous screws for fixation of femoral neck fracture in adults: A systematic review. Int J Surg, 2018, 52: 89-97.
9. Weil YA, Qawasmi F, Liebergall M, et al. Use of fully threaded cannulated screws decreases femoral neck shortening after fixation of femoral neck fractures. Arch Orthop Trauma Surg, 2018, 138(5): 661-667.
10. Papanastassiou ID, Mavrogenis AF, Kokkalis ZT, et al. Fixation of femoral neck fractures using divergent versus parallel cannulated screw. J Long Term Eff Med Implants, 2011, 21(1): 63-69.
11. Galal S, Nagy M. Non-parallel screw fixation for femoral neck fractures in young adults. J Clin Orthop Trauma, 2017, 8(3): 220-224.
12. Yin H, Pan Z, Jiang H. Is dynamic locking plate (Targon FN) a better choice for treating of intracapsular hip fracture? A meta-analysis Int J Surg, 2018, 52: 30-34.
13. Lu-Yao GL, Keller RB, Littenberg B, et al. Outcomes after displaced fractures of the femoral neck. A meta-analysis of one hundred and six published reports. J Bone Joint Surg (Am), 1994, 76(1): 15-25.
14. 李伟龙, 余霄, 庞清江. 股骨颈骨折内固定术后股骨颈短缩的相关研究进展. 中华骨科杂志, 2016, 36(6): 378-384.