切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (06) : 746 -752. doi: 10.3877/cma.j.issn.1674-134X.2018.06.001

所属专题: 文献

临床论著

空心钉与髓内钉治疗青壮年股骨颈不稳定骨折的疗效观察
陈鹏1, 卓成龙2,(), 计飞1, 陈一舟1, 仲荣琴1   
  1. 1. 314000 嘉兴,浙江新安国际医院骨科
    2. 245000 黄山,安徽省黄山市人民医院
  • 收稿日期:2018-05-26 出版日期:2018-12-01
  • 通信作者: 卓成龙

Comparison between directed anterior appoach assisted cannulated screw and intramedullary fixation for young adults with unstable femoral neck fractures

Peng Chen1, Chenglong Zhuo2,(), Fei Ji1, Yizhou Chen1, Rongqin Zhong1   

  1. 1. Orthopedic Trauma Department, Zhejiang Sian International Hospital, Jiaxing 314000, China
    2. Huangshan City People's Hospital, Huangshan 245000, China
  • Received:2018-05-26 Published:2018-12-01
  • Corresponding author: Chenglong Zhuo
  • About author:
    Corresponding author: Zhuo Chenglong, Email:
引用本文:

陈鹏, 卓成龙, 计飞, 陈一舟, 仲荣琴. 空心钉与髓内钉治疗青壮年股骨颈不稳定骨折的疗效观察[J/OL]. 中华关节外科杂志(电子版), 2018, 12(06): 746-752.

Peng Chen, Chenglong Zhuo, Fei Ji, Yizhou Chen, Rongqin Zhong. Comparison between directed anterior appoach assisted cannulated screw and intramedullary fixation for young adults with unstable femoral neck fractures[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(06): 746-752.

目的

分析在直接前侧入路(DAA)辅助下空心螺钉与Intertan髓内固定治疗青壮年移位不稳型股骨颈骨折的临床疗效。

方法

回顾分析浙江新安国际医院骨科2014年1月至2016年12月采用DAA入路切开复位治疗青壮年移位不稳定型(Garden Ⅲ、Ⅳ型)股骨颈骨折患者,资料均为GardenⅢ、Ⅳ不稳定型股骨颈骨折,24 h之内完成手术,年龄<60岁且随访资料完整;排除同侧转子间骨折、转子下骨折、股骨干骨折,长期使用大剂量激素或酗酒患者。DAA辅助空心钉螺钉内固定组(空心钉组)90例,DAA辅助Intertan髓内钉固定组(髓内钉组)89例,采用SPSS 21.0统计学软件对数据进行统计学分析。采取t检验和χ2检验比较手术时间、透视次数、出血量、住院日、骨折愈合时间、骨折不愈合及股骨头缺血性坏死率、Harris评分。

结果

两组在年龄、性别、Garden分型比较上,差异无统计学意义(均P>0.05),有可比性。空心钉组在手术时间(45.4±15.6)min、透视次数(6.5±3.4)次、出血量(90.5±24.5)ml方面优于髓内钉组[分别为(75.2±12.4)min,(9.3±4.6)次,(159.7±40.2)ml](均为P<0.01);空心钉组在住院日(7.2±2.1)d方面与髓内钉组(8.2±1.3)d没有差异(t=-1.567,P>0.05)。髓内钉组愈合时间(2.8±0.8)月,短于空心钉组[(3.8±0.7)月,(t=5.375,P<0.01)]。髓内钉组骨折不愈合、股骨头缺血性坏死4例明显少于空心钉组15例(χ2=6.005,P<0.05);Harris评分优良率空心钉组低于髓内钉组(χ2=7.338,P<0.01)。

结论

青壮年移位不稳定型股骨颈骨折早期采用DAA辅助入路Intertan髓内固定方法治疗可在直视下完成骨折复位,术后恢复快,骨折愈合率高,股骨头坏死发生率低,疗效满意。

Objective

To analyze the clinical efficacy of direct anterior approach(DAA)-assisted cannulated screw and Intertan intramedullary fixation in the treatment of unstable femoral neck fractures in young adults.

Methods

From January 2014 to December 2016, 179 cases of displaced unstable (Garden III or IV)femoral neck fractures in young adults were treated by open reduction of direct anterior approach (DAA). Inclusion creteria: surgery is completed within 24 hours, age<60 years old and follow-up data intact; exclusion creteria: ipsilateral intertrochanteric fractures, subtrochanteric fractures, femoral shaft fractures, long-term use of large doses of hormones or alcohol abuse patients.Ninety cases were treated by DAA-assisted cannulated screw fixation in group A and 89 cases were treated by DAA-assisted Intertan intramedullary fixation in group B. Data were statistically analyzed using SPSS 21.0 statistical software with t test and χ2 test to compare the operation time, the number of fluoroscopy, the amount of bleeding, the hospitalization day, the fracture healing time, the fracture nonunion, the avascular necrosis rate of the femoral head, and the Harris score.

Results

There was no significant difference in age, gender, and Garden classification between the two groups (all P>0.05), which was comparable. Group A was superior to group B in terms of operation time[group A (35.4±15.6) min, group B(55.2±12.4) min], number of X-ray exminations [group A (6.5±3.4) times, group B(9.3±4.6) times], and bleeding volume[group A (70.5±24.5) ml, group B(129.7±40.2) ml](all P<0.01). Group A did not differ from group B in hospitalization day[(7.2±2.1)d vs. (8.2±1.3)d, t =-1.567, P>0.05]. The healing time of group B (2.8±0.8) months was shorter than that of group A (3.8±0.7) months(t=5.375, P<0.01). In group B, nonunion and avascular necrosis of the femoral head occurred in four cases, which were significantly less than those in group A (15 cases)(χ2 =6.005, P<0.05). In group B, three cases were poor in Harris score, which were less than group A (15 cases were poor)(χ2 =7.338, P<0.01).

Conclusion

Young adults with unstable femoral neck fracture treated with DAA-assisted Intertan intramedullary fixation can achieve completely reduction of bone under direct vision, with fast postoperative recovery, high healing rate, and low incidence of femoral head necrosis; the effect is satisfactory.

图1 手术基本步骤。图A为确定DAA切口;图B为显露旋股外动脉结扎;图C为显露股骨颈骨折处,克氏针"遥感技术"复位;图D为透视下临时固定股骨头影像;图E为术中透视下Intertan髓内钉
表1 两组患者一般资料比较
表2 两组结果及预后比较
图2 典型病例术前影像图。图A为术前骨盆X线正位片,示左股骨颈骨折;图B~E分别为骨盆CT水平位、矢状位、冠状位、三维重建图,示左股骨颈骨折处
图6 术后12个月左股骨颈正侧位X线片,未见股骨头塌陷、坏死及股骨头高度丢失
图7 术后18个月左股骨颈CT,显示水平位、冠状位、矢状位均无明显股骨头缺血性坏死
图8 术后18个月左股骨颈MRI,显示水平位、T1和T2冠状位股骨头无塌陷,无缺血性坏死
[1]
Ly TV, Swiontkowski MF. Treatment of femoral neck fractures in young adults[J].Instr Course Lect,2009, 58(1):69-81.
[2]
Pauyo T, Drager J, Albers A, et al. Management of femoral neck fractures in the young patient: a critical analysis review[J]. World J Orthop, 2014, 5(3): 204-217.
[3]
Florschutz AV, Langford JR, Haidukewych GJ, et al. Femoral neck fractures: current management[J]. J Orthop Trauma, 2015, 29(3): 121-129.
[4]
Naumov I, Wiegand N, Patczai B, et al. Differential scanning calo-rimetrie examination of the human hyaline cartilage of the femoral head after femoral neck fracture[J]. J Therm Anal Calorim, 2012, 108(1): 59-65.
[5]
Kang JS, Moon KH, Shin JS, et al. Clinical results of internal fixationof subcapital femoral neck fractures[J]. Clin Orthop Surg, 2016, 8(2): 146-152.
[6]
Madhu TS, Akula M, Scott BW,et al.Management to developmental dislocation of hip: does chanping the hip abduction angle in the spica affect the rate of avascular necrosis of the femoral head [J]. J Pediatr Orthop B,2013,22(3):184-188.
[7]
Ai ZS, Gao YS, Sun Y, et al. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients[J]. J Orthop Sci, 2013, 18(2): 271-276.
[8]
Windolf M, Braunstein V, Dutoit C,et al. Is a helical shaped implant a superior alternative to the dynamic hip screw for unstable femoral neck fractures a biomechanical investigation[J]. Clin Biomech(Bristol,Avon),2009,24(1): 59-64.
[9]
Papakostidis C, Panagiotopoulos A, Piccioli A, et al. Timing of internal fixation of femoral neck fractures. A systematic review and meta-analysis of the final outcome[J]. Injury, 2015, 46(3): 459-466.
[10]
Lein T, Bula P, Jeffries J, et al. Fractures of the femoral neck[J]. Acta Chir Orthop Traumatol Cech, 2011, 78(1): 10-9.
[11]
智春升,邬波,金冶华,等.DAA入路空心钉固定治疗青壮年股骨颈骨折的疗效观察[J].中华骨与关节外科杂志,2017,10(2):132-135.
[12]
Zhao DW, Hu YC. Chinese experts consensus on the diagnosis and treatment of osteoneerosis of the femoral head in adults[J]. Orthop Surg, 2012, 4(3): 125-130.
[13]
Windolf M, Braunstein V, Dutoit C, et al. Is a helical shaped implanta superior alternative to the dynamic hip screw for unstable femoral neck fractures: a biomechanical investigation[J]. Clin Biomech (Bristol, Avon), 2009, 24(1): 59-64.
[14]
Kaynak G, Ünlü C, Güven MF, et al. Intramedullary nail with integrated cephalocervical screws in the intertrochanteric fractures treatment: position of screws in fracture stability[J]. Ulus Travma Acil Cerrahi Derg, 2018, 24(3):268-273.
[15]
Gavaskar AS, Tummala NC, Srinivasan P, et al. Helical blade or the integrated lag screws: a matched pair analysis of 100 patients with unstable trochanteric fractures[J]. J Orthop Trauma, 2018, 32(6):274-277.
[16]
Zhang J, Cao L H, Chen X, et al. Comparison of PFNA and Intertan intramedullary nail in treating unstable femoral intertrochanteric fractures[J]. J Orthop Traumatol, 2017, 30(7):597-601.
[17]
张晟,胡岩君,余斌.不同内固定方式固定Pauwels Ⅲ型股骨颈骨折模型的有限元分析[J].中国矫形外科杂志,2017,25 (2):163-169.
[18]
周军杰,曹成福,庞金辉,等.不同内固定手术方法治疗不稳定型股骨颈骨折的对照分析[J].中国矫形外科杂志,2013,21(2):136-139.
[19]
Rupprecht, Martin MD, Grossterlinden, et al. A comparative biomechanical analysis of fixation devices for unstable femoral neck fractures: the Intertan versus cannulated screws or a dynamic hip screw[J]. J Trauma,2011,10 (71):625-634.
[20]
张长青,黄轶刚.股骨颈骨折的治疗理念与新技术[J].中华创伤骨科杂志,2016,18(8):645-646.
[1] 刘正宇, 刘春风, 王振. 改良后外侧入路半髋置换治疗股骨颈骨折的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 409-413.
[2] 卢国良, 潘耀成. 比较不同类型假体用于骨质疏松症的老年股骨颈骨折[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 277-279.
[3] 欧梁, 齐麒, 胡伟伟, 卢敏, 黄彦昌, 黄维琛, 匡建军. 股骨颈动力交叉钉系统与其它内固定治疗股骨颈骨折对比[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 92-105.
[4] 宋红霞, 吴玩呈. 内镜下甲状腺手术切口入路发展的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(04): 470-472.
[5] 胡剑平, 王振乾, 张龙, 尹任其, 陈涵, 赵任, 吕强. 尾侧中间联合入路与尾侧入路在腹腔镜右半结肠癌根治术中的应用对比[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(02): 196-199.
[6] 周迪, 全志伟. 规范化胆囊良性疾病诊治流程减少胆囊癌误诊误治[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 749-753.
[7] 王晓梅, 刘宇, 董金磊, 刘凡孝, 王成龙, 李连欣. 单一前方入路内固定对肱骨近端骨折合并肱骨头后脱位的疗效分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 319-325.
[8] 赵静磊, 陈晓婷, 夏莹, 黄维佳, 周菊, 刘芳. 锁骨骨折切开复位内固定术后患者肩关节功能恢复的风险因素研究[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 216-222.
[9] 冷昆鹏, 孟钰童, 单磊, 刘洋, 周君琳. 不同手术入路治疗肱骨远端冠状面骨折的临床疗效观察[J/OL]. 中华肩肘外科电子杂志, 2024, 12(02): 127-134.
[10] 谭明明, 战世强, 侯宏涛, 曾翔硕. 经皮微创椎弓根螺钉内固定术对骨质疏松脊柱压缩性骨折患者临床研究[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(06): 349-354.
[11] 张于, 程亮亮, 王峰, 赵德伟. 2枚与3枚空心钉治疗无移位股骨颈骨折的疗效对比[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 281-286.
[12] 茹江英, 廖启宇, 温国洪, 潘思华, 刘栋, 张皓琛, 牛云飞. 直接前方入路和后外侧入路半髋关节置换治疗老年痴呆股骨颈骨折的疗效比较[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 287-293.
[13] 单良, 刘怡, 于涛, 徐丽. 老年股骨颈骨折术后患者心理弹性现状及影响因素分析[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(05): 294-300.
[14] 冉仁国, 罗政, 廖鑫, 张付民. 低频脉冲电磁场对骨质疏松性胸腰椎骨折内固定术后康复的促进作用[J/OL]. 中华老年骨科与康复电子杂志, 2024, 10(01): 39-45.
[15] 杨德红, 万宇晖, 杨凯, 陈爱林, 戴纯刚, 陈延明, 陈炳霖, 朱卿. 非优势供血侧眶上锁孔入路显微手术治疗破裂前交通动脉瘤的临床疗效[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(02): 115-120.
阅读次数
全文


摘要