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中华老年骨科与康复电子杂志 ›› 2023, Vol. 09 ›› Issue (04) : 201 -208. doi: 10.3877/cma.j.issn.2096-0263.2023.04.002

股骨骨折

股骨重建钉治疗股骨颈骨折的疗效观察
宋晓亮, 郝海虎, 刘渊, 李浩江, 雷晓晶, 邵新中, 李卿源()   
  1. 046000 山西省长治市第二人民医院创伤骨科
    030000 太原,山西白求恩医院创伤骨科
    056000 邯郸市第一医院创伤骨科
    050011 石家庄,河北医科大学第三医院手外科
    300220 天津医院手显微外科一病区
  • 收稿日期:2023-03-31 出版日期:2023-08-05
  • 通信作者: 李卿源
  • 基金资助:
    山西省科技厅自然科学研究面上项目(202103021224347)

Application of femoral reconstructing nail in the treatment of femoral neck fractures

Xiaoliang Song, Haihu Hao, Yuan Liu, Haojiang Li, Xiaojing Lei, Xinzhong Shao, Qingyuan Li()   

  1. Department of Trauma Orthopaedics, Changzhi Second People's Hospital, Changzhi 046000, China
    Department of Trauma Orthopaedics, Shanxi Norman Bethune Hospital, Taiyuan 030000, China
    Department of Trauma Orthopaedics, Handan First Hospital, Handan 056000, China
    Department of Hand Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang 050011, China
    Department of Hand Microsurgery, Tianjin Hospital, Tianjin 300220, China
  • Received:2023-03-31 Published:2023-08-05
  • Corresponding author: Qingyuan Li
引用本文:

宋晓亮, 郝海虎, 刘渊, 李浩江, 雷晓晶, 邵新中, 李卿源. 股骨重建钉治疗股骨颈骨折的疗效观察[J/OL]. 中华老年骨科与康复电子杂志, 2023, 09(04): 201-208.

Xiaoliang Song, Haihu Hao, Yuan Liu, Haojiang Li, Xiaojing Lei, Xinzhong Shao, Qingyuan Li. Application of femoral reconstructing nail in the treatment of femoral neck fractures[J/OL]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2023, 09(04): 201-208.

目的

观察分析使用股骨重建钉治疗股骨颈骨折的临床效果。

方法

回顾性分析了长治市二院自2018年1月至2021年12月期间采用股骨重建钉治疗股骨颈骨折患者的临床资料,并与同期采用倒三角空心钉固定的患者进行对比。主要评价指标有两组患者的手术时间、出血量、术后2 d VAS评分、术后早期并发症及术后开始部分负重时间,并采用Harris评分评价髋关节功能。另外对患者骨折复位、愈合情况及股骨颈短缩程度进行评估。

结果

45例患者均获随访,随访时间9~18个月,平均(13.0±3.1)月。其中男27例,女18例,年龄从18~75岁。重建钉组患者手术时间及出血量分别为(82.7±16.2)min、35.00(30.00,50.00)ml均多于空心钉组的(64.0±18.2)min、17.50(13.75,30.00)ml(P<0.05);术后2 d VAS评分重建钉组[2.00(1.00,2.00)分]与空心钉组[2.00(1.00,2.00)分]无差异。空心钉组开始部分负重时间[8.00(6.00,10.00)周],晚于重建钉组[2.00(2.00,3.00)周](P<0.05)。髋关节Harris评分重建钉组[94.00(88.00,98.00)分]高于空心钉组[84.00(71.75,91.00)分](P<0.05)。术后定期复查X线片,空心钉组1例患者在随访期内未愈合,1例螺钉切出,1例未愈合并有股骨头坏死。重建钉组1例患者未愈合合并股骨头坏死。空心钉组骨折愈合时间[9.00(7.00,10.00)个月]与重建钉组[8.00(7.00,8.00)个月]无差异。空心钉组股骨颈短缩长度[4.00(2.00,7.00)mm]长于重建钉组[1.00(0.00,2.00)mm],(P<0.05)。

结论

使用股骨重建钉固定股骨颈骨折具有明显的临床优势,如可早期负重、股骨颈短缩程度轻、髋关节功能好等,且股骨重建钉的临床应用时间长、技术成熟,易于推广。

Objective

To investigate the clinical effect of femoral reconstruction nail in the treatment of femoral neck fractures.

Methods

A retrospective analysis was performed on 45 patients with femoral neck fractures in our hospital from January 2018 to Decemberr 2021.There were 30 patients in the CCS group and 15 patients in the femoral reconstruction nail group, with range 18 to 75 years.The main evaluation indicators for both groups of patients include surgical time, bleeding volume, VAS score at 2 days after surgery, early postoperative complications, and time to start partial weight-bearing after surgery, Harris score of the hip joint, fracture reduction, healing status, and degree of femoral neck shortening.

Results

45patients were followed up for 9 to 18 months, mean (13.0±3.1) months. There were 27 males and 18 females, with range 18 to 75. Both groups showed the average operation time was [(64±18.2) vs (82.7±16.2) min, P<0.05], the median bleeding volume was [17.50 (13.75, 30.00) vs 35.00(30.00, 50.00)ml, P<0.001], the median VAS score at 2 days after surgery was [2.00(1.00, 2.00) vs 2.00(1.00, 2.00), P=0.227], the median postoperative partial weight-bearing time was [8.00(6.00, 10.00) vs 2.00(2.00, 3.00) weeks, P<0.001], the median hip joint Harrisscore was [84.00(71.75, 91.00) vs 94.00(88.00, 98.00), P<0.05], the median fracture healing time was [9.00(7.00, 10.00) vs 8.00(7.00, 8.00) months, P=0.075], the median femoral neck shortening length was [4.00(2.00, 7.00) vs 1.00(0.00, 2.00)mm, P<0.001]. Among them, a patient in the CCS group did not heal during the follow-up period, a patient had screw penetration, and a patient did not heal with femoral head necrosis. A patient in the femoral reconstruction nail group did not heal with femoral head necrosis.

Conclusion

The fixation of femoral neck fractures with femoral reconstruction nails has significant clinical advantages, such as early weight bearing, mild shortening of the femoral neck, and good hip joint function.In addition, femoral reconstruction nails are a mature technology that has a long clinical application time and is easy to promote.

表1 股骨颈骨折患者排除原因汇总
表2 两组股骨颈骨折患者一般资料比较
图1~2 通过测量外露螺钉钉尾长度来评估短缩距离。具体方法是通过测量空心钉钉尾沿螺钉轴线到骨表面的长度(图2),减去术后初始射线照片中测量的长度(图1)来计算
表3 两组股骨颈骨折患者临床结果比较
表4 两组股骨颈骨折患者术后影像学结果比较
图10~15 重建钉组患者,男,59岁,因"摔伤致右髋部肿痛伴活动受限5 h"入院,入院诊断:右侧股骨颈骨折(GardenI型),入院3 d后行闭合复位重建钉内固定术。图10~11 术前X线及CT片,示股骨颈骨折(GardenI型);图12~13 术后第2天X线片,结果见骨折复位满意、内固定位置良好;图14~15 术后13个月X线片,显示骨折愈合,头钉无退出,股骨颈无短缩,右髋关节功能良好
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