空心钉结合内侧支撑钢板在Pauwels Ⅲ型股骨颈骨折中的应用

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (1786 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的研究空心钉结合内侧支撑钢板在PauwelsⅢ型股骨颈骨折治疗中的应用效果。方法 2015年11月至2018年10月，选取符合纳入标准的PauwelsⅢ型股骨颈骨折患者58例，随机分为空心钉、空心钉结合内侧支撑钢板两组，每组各29例。观察和比较两组患者平均手术时间、术中出血量、术中透视次数、骨折复位质量、术后并发症(如退钉、骨不连、股骨头坏死率、髋内翻、股骨颈短缩等)，术后6、12、24个月Harris评分评定髋关节功能情况。结果患者均获随访，随访时间24～56个月，平均(30.6±6.1)个月。(1)与空心钉组比较，空心钉结合钢板组的平均手术时间更长、术中出血量更多，但术中透视次数少，两组比较差异均有统计学意义(P＜0.05)。(2)空心钉结合钢板组骨折复位优良率高，两组比较差异有统计学意义(P＜0.05)。(3)空心钉结合钢板组术后退钉、股骨头坏死、髋内翻、股骨颈短缩等并发症的发生率均低于空心钉组，两组比较差异有统计学意义(P＜0.05)，术后骨不连发生率两组相当，差异无统计学意义(P＞0.05)。(4)与空心钉组比较，空心钉结合钢板组在术后6、12、24个月的Harris评分明显更高，差异有统计学意义(P＜0.05)。结论空心钉结合内侧支撑钢板在PauwelsⅢ型股骨颈骨折治疗中的疗效较好，术后并发症发生率低，可为临床治疗该类型骨折提供参考。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	沈正清
	谢景凌
	王旭东
	王俊鸿
	肖志满
	刘斌伟

关键词 ：股骨颈骨折, 空心钉, 内侧支撑钢板

Abstract：Objective To study the application of cannulated screw combined with medial buttress plate in the treatment of Pauwels typeⅢ femoral neck fracture.Methods From November 2015 to October 2018，58 patients with Pauwels type Ⅲ femoral neck fractures who met the inclusion criteria wereenrolled and randomly divided into two groups：cannulated screw，cannulated screwscombined with medial buttress plate，with 29 cases in each group.The average operation time，intraoperative blood loss，intraoperative fluoroscopy，postoperative complications (such as nail removal，nonunion，femoral head necrosis rate，hip varus，femoral neck shortening，etc.) were observed and compared between the two groups.Harris Hip Score at 6，12and 24 months after operation were used to assess hip joint function.Results All patients were followed up 24~56 months，with an average of (30.6±6.1)months.(1)Compared with the cannulated screw group，the average operation time and intraoperative blood loss of the cannulated screwcombined with medial buttress plate group were longer and more，but the time of intraoperative fluoroscopy was less，and the difference was statistically significant (P＜0.05).(2) The excellent and good rate of fracture reduction in cannulated screwcombined with medial buttress plate group is high，and the difference is statistically significant.(3) The incidence of postoperative complications such as screw withdrawal，femoral head necrosis，hip varus，and femoral neck shortening in cannulated screw combined withmedial buttress plate group was lower than that of the cannulated screw group，and the difference was statistically significant (P＜0.05).The incidence of nonunion was similar between the two groups，and the difference was not statistically significant (P＞0.05).(4)Compared with the cannulated screw group，the Harris Hip Score of the cannulated screw combined with medial buttress plate group was significantly higher at 6，12，and 24 months after surgery，and the difference was statistically significant.(P＜0.05).Conclusion Cannulated screw combined with medial buttress plate is more effective in the treatment of Pauwels tape Ⅲ femoral neck fracture.and the postoperative complication rate is low，which can provide a reference for clinical treatment of this type of fracture.

Key words： femoral neck fracture cannulated screw medial buttress plate

基金资助:泉州市卫生健康委科研资助项目(201817)

作者简介: 沈正清(1978－ )，男，副主任医师，福建省晋江市医院骨科，362200。

引用本文:

沈正清，谢景凌，王旭东，王俊鸿，肖志满，刘斌伟. 空心钉结合内侧支撑钢板在Pauwels Ⅲ型股骨颈骨折中的应用[J]. 实用骨科杂志, 2021, 27(3): 205-209.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2021/V27/I3/205

［1］张英泽.股骨骨折：临床创伤骨科流行病学［M］.北京：人民卫生出版社，2014：177-179.
［2］Freitas A，Torres GM，Souza AC，et al.Anlysis on the mechanical resistance of fixation of femoral neck fractures in synthetic bone，using the dynamic hip system and an anti-rotion screw［J］.Rev Bras Ortop，2014，49(6)：586-592.
［3］Spence D，Dimauro JP，Miller PE，et al.Osteonecrosis after femoral neck fractures in children and adolescents：Analysis of risk factors［J］.J Pediatr Orthop，2016，36(2)：111-116.
［4］张成宝，马信龙，马剑雄，等.股骨颈骨折空间移位程度与内固定术后股骨头缺血性坏死的相关性研究［J］.中华创伤骨科杂志，2016，18(2)：133-137.
［5］ Liu C，Liu MT，Li P，et al.Efficacy evaluation for the treatment of subcapital femoral neck fracture in young adults by capsulotomy reduction and closed reduction［J］.Chin Med J，2015，128(4)：483-488.
［6］殷浩，周恩昌，潘政军，等.4枚空心钉与3枚空心钉结合支持钢板内固定治疗PauwelsⅢ型股骨颈骨折的有限元分析［J］.中国组织工程研究，2019，23(32)：5133-5137.
［7］任栋，程培焱，宋朝晖，等.不同数量和空间构型的空心钉拉力螺钉治疗股骨颈骨折的有限元分析［J］.中华创伤杂志，2017，33(9)：815-822.
［8］申洪全，陆慧，张孝华，等.计算机辅助2枚空心钉置入内固定治疗股骨颈骨折的生物力学分析［J］.中国组织工程研究，2020，24(6)：882-887.
［9］阮哲，朱勇，林涨源，等.正三角和倒三角排列空心螺钉治疗股骨颈骨折的系统评价［J］.中国组织工程研究，2020，24(6)：924-930.
［10］贺延雷，李强，李国良.“F”形空心钉与空心螺钉内固定治疗股骨颈骨折的效果比较［J］.医学信息，2020，33(8)：113-115.
［11］易波德，梁斌.2枚空心钉内固定治疗股骨颈骨折GardenⅠⅡⅢ型临床疗效分析［J］.中国临床新医学，2020，13(2)：176-179.
［12］张长青，黄秩刚.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.
［13］Ye Y，Hao J，Mauffrey C，et al.Optimizing stability in femoral neck fracture fixation［J］.Orthop，2015，38(10)：625-630.
［14］Min BW，Kim SJ.Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture［J］.Orthop，2011，34(5)：349.
［15］Kumapuli SC，Schramski MJ，Lee AS，et al.Biomechanical analysis of augmented plate fixation for the treatment of vertical shear femoral neck fractures［J］.Orthop Trauma，2015，29(3)：144-150.
［16］Mir H，Collinge C.Application of a medial butter plate may prevent many treatment failures seen after fixation of vertical femoral neck fractures in young adults［J］.Med Hypotheses，2015，84(5)：429-433.
［17］ Leslie MP，Jamali A，Wolinsky P.Treatment of femoral head fractures［J］.Tech Orthop，2010，25(3)：155-159.
［18］田伟，王满宜.骨折［M］.北京：人民卫生出版社，2013：684-685.
［19］Lavigne M.Kalhor M，Beck M，et al.Distribution of vascular foramina around the femoral head and neck junction：relevance for conservative intracapsular procedures of the hip［J］.Orthop Clin North Am，2005，36(2)：171-176.
［20］Mei J，Ni M，Wang G，et al.Number and distribution of nutrient foramina within the femoral neck and their relationship to the retinacula of Weitbrecht：an anatomical study［J］.Anat Sci Int，2017，92(1)：91-97.
［21］Putnam SM，Cllinge CA，Gardner MJ，et al.Vascular anatomy of the medial femoral neck and implications for surface plate fixation［J］.Orthop Trauma，2019，33(3)：111-115.