中青年股骨颈骨折外科脱位入路开放复位内固定△

Surgical dislocation of the hip for open reduction and internal fixation of femoral neck fracture in the middle- aged and young adults

摘要:

［目的］ 评价髋关节外科脱位入路开放复位内固定治疗中青年股骨颈骨折的临床效果。［方法］ 2018 年 6 月—2019 年 6 月，本科采用髋关节外科脱位入路开放复位内固定治疗中青年股骨颈骨折 15 例（15 髋）。总结临床效果与影像资料。［结果］15 例患者均顺利完成手术，手术时间（100.00±12.32）min，术中出血量（300.00±26.99）ml。切口均 I 期愈合，无伤口感染和深静脉血栓形成等早期并发症。所有患者均获随访 （13.80±1.61） 个月，下地行走时间 （13.00±1.13） 周，完全负重时间 （16.46±1.41）周。末次随访时患髋 Harris 和 JOA 评分较术后第 3 个月显著增加（P<0.05）。影像方面，解剖复位 12 例，可接受复位 3 例，无复位不良，解剖复位率为 80.00%。末次随访时 X 线片示股骨颈内侧支撑钢板与空心螺钉均在位，影像骨折愈合时间为 4~6 个月。［结论］髋关节外科脱位入路开放复位内固定治疗中青年股骨颈骨折临床效果满意。

Abstract:

[Objective] To evaluate the clinical outcomes of open reduction and internal fixation (ORIF) by surgical hip dislocation (SHD) for femoral neck fracture in the middle-aged patients and young adults. [Methods] From June 2018 to June 2019, 15 middle-aged and young patients (15 hips) received ORIF by SHD approach for femoral neck fracture. The clinical results and imaging data were summa- rized. [Results] All the 15 patients in this study had the surgical procedures completed successfully with operation time of (100.00±12.32) min, intraoperative blood loss of (300.00±26.99) ml, and well incisions healing, whereas without early complications such as wound infec- tion and deep vein thrombosis. All the patients were followed up for (13.80±1.61) months, with walking time of (13.00±1.13) weeks, and full weight-bearing activity time of (16.46±1.41) weeks postoperatively. The Harris and JOA hip scores significantly improved at the latest fol- low-up compared with those at 3 months postoperatively (P＜0.05) . In terms of imaging, anatomical reduction achieved in 12 cases, and ac- ceptable reduction in 3 cases, and no poor reduction was found, with the anatomical reduction rate of 80.00%. The regular X-ray checks showed that both the medial femoral neck buttress plate and the cannulated screw remained in place, and fracture healing time ranged from 4 to 6 months. [Conclusion] The ORIF by SHD does achieve satisfactory clinical outcomes for femoral neck fracture in middle-aged and young adults in this study.