股骨颈骨折经上关节囊入路开放复位内固定△

Open reduction and internal fixation of femoral neck fractures via supercapsular percutaneously assisted total hip ap⁃ proach

摘要:

[目的]介绍采用经上关节囊入路开放复位内固定治疗股骨颈骨折的手术技术和初步临床效果。[方法]采用上述技术治疗 21 例股骨颈骨折。行髋外侧切口，于臀中肌后缘分离，辨认臀小肌及梨状肌间隙，显露上方关节囊。切开关节囊，显露股骨颈骨折，评估后上部骨质压缩或骨结构破坏情况，复位骨折，恢复颈干角及前倾角，取自体髂骨块支撑植骨于股骨颈后侧骨缺损处，采用空心钉内固定。[结果]所有患者均完成手术治疗，术中无重要血管、神经损伤等并发症。随访 12~26 个月， 随访过程中，1 例发生股骨头塌陷坏死伴空心钉退钉，行人工髋关节置换治疗。术后 1 年髋关节 Harris 评分(85.0±9.4)分。影像方面，所有患者股骨颈骨折均骨性愈合；与完全负重前相比，术后 12 个月，股骨颈水平短缩和垂直短缩均无显著变化 (P＞ 0.05)。[结论]经上关节囊微创入路切开复位，内固定并植骨治疗股骨颈骨折，可减少股骨颈短缩的发生，骨折愈合率高，治疗效果满意。

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of open reduction and internal fixation (OR- IF) of femoral neck fractures via supercapsular percutaneously assisted total hip approach (SuperPath) . [Methods] Twenty one patients re- ceived ORIF through the SuperPath for femoral neck. After a lateral incision above the greater trochanter was made, the posterior edge of the gluteal medius was separated to expose the upper capsule by separation of the space between the gluteus minimus and piriformis. Capsuloto- my was conducted to expose the fractured site of the femoral neck, and identify the fracture compression and bone defect of the posterosuperi- or femoral neck. Reducing fracture to restore the neck shaft angle and anteversion with a strut bone block autograft harvested form the iliac crest packed into the bone defect, the fractures were fixed by 3 cannulated screws. [Results] All patients had the surgical procedures per- formed smoothly without serious complications, such as neurovascular injuries, and were followed up for 12~26 months. Except one patient who had revision total hip arthroplasty due to necrosis of femoral head accompanied with screw withdrew during the follow-up, all patients got satisfactory functional recovery with Harris score of (85.0±9.4) at 12 months postoperatively. Radiographically, all patients got solid frac- ture healing without significant changes of femoral neck shortening transversely and vertically at 12 months postoperatively compared with those before full weight-bearing activity (P＞0.05) . [Conclusion] This ORIF combined with bone autografting via SuperPath does reduce the possibility of femoral neck shortening, improve fracture healing, and achieve satisfactory clinical outcome for femoral neck fractures.