两种入路开放复位内固定股骨头骨折比较

Comparison of two approaches for open reduction and internal fixation of femoral head fractures

摘要:

[目的] 比较Ganz 入路与Kocher-Langenbeck （K-L） 入路开放复位内固定Pipkin I、II 型股骨头骨折的临床疗效。[方法] 回顾性分析2017 年4 月—2022 年2 月本院治疗的24 例股骨头骨折患者的临床资料，根据医患沟通结果，12 例采用Ganz 入路，另外12 例采用K-L 入路，比较两组临床和影像结果。[结果] 两组患者均顺利完成手术，Ganz 组在手术时间[(94.6±15.1) min vs (109.2±14.6) min, P=0.025] 和术中失血量[(254.2±78.2) ml vs (316.7±65.1) ml, P=0.045] 均显著优于K-L 组，两组切口长度、切口愈合等级的差异均无统计学意义（P＞0.05）。随访时间平均（17.1±8.4） 个月，术后随时间推移，两组疼痛视觉模拟评分（visual analogue scale, VAS） 及Harris 评分显著增加（P＜0.05），术后1 个月Ganz 组的Harris 评分显著优于K-L 组[(44.1±2.5) vs (40.2±3.0), P=0.002]，其他相应时间点，两组VAS、Harris 评分的差异均无统计学意义（P＞0.05）。影像方面，两组骨折复位质量的差异无统计学意义（P＞0.05）。末次随访时，两组Brooker 分级、Ficat 分期及Tonnis 分级的差异均无统计学意义（P＞0.05）。[结论] 相较于K-L 入路，Ganz 入路具有手术时间短、术中出血少、术后髋关节功能恢复快等优势。

Abstract:

[Objective] To compare the clinical efficacy of Ganz approach versus Kocher-Langenbeck (K-L) approach for open reduc-tion and internal fixation (ORIF) of Pipkin type I and II femoral head fractures. [Methods] A retrospective study was conducted on 24 pa-tients who receive ORIF of femoral head fractures in our hospital from April 2017 to February 2022. According to the results of doctor-pa-tient communication, 12 patients had ORIF performed through the Ganz approach, while the other 12 patients were through K-L approach.The clinical and imaging documents of the two groups were compared. [Results] All patients in both groups were successfully operated on.The Ganz group proved significantly superior to the K-L group in terms of operative time [(94.6±15.1) min vs (109.2±14.6) min, P=0.025]and intraoperative blood loss [(254.2±78.2) ml vs (316.7±65.1) ml, P=0.045], despite of insignificant differences in incision length and inci-sion healing grade between the two groups (P＞0.05). As time went during follow-up period lasted for (17.1±8.4) months in a mean, the visu-al analogue scale (VAS) for pain and Harris score of the two groups were significantly increased (P＜0.05). The Ganz group was significantlybetter than the K-L group regarding Harris score one month after surgery [(44.1±2.5) vs (40.2±3.0), P=0.002], regardless of the fact thatthere were no significant differences in VAS score, and Harris score at other corresponding time points between the two groups (P＞0.05).Radiographically, there was no significant difference in fracture reduction quality between the two groups (P＞0.05). At the last follow-up,there were no significant differences in Brooker grade, Ficat stage and Tonnis grade between the two groups (P＞0.05). [Conclusion] TheGanz approach has the advantages of shortening operation time, reducing intraoperative bleeding, and improving recovery of hip function af-ter operation over the K-L approach for femoral head fractures.