C臂三维影像牵引器复位动力交叉钉固定股骨颈骨折△

Femoral neck system for internal fixation of femoral neck fracture under retractor traction and C-arm 3D image monitor⁃ ing

摘要:

[目的]介绍 C 形臂三维影像下牵引器复位动力交叉钉（femoral neck system, FNS）内固定治疗中青年股骨颈骨折的手术技术和初步临床效果。[方法] 对 21 例中青年股骨颈骨折患者采用 C 形臂三维影像下牵引器复位 FNS 内固定治疗。患侧垫高 40°，斜侧卧位，于股骨髁上穿针，安装骨折牵引器，施加纵向牵引力，内收内旋患肢使骨折复位。股骨大粗隆行纵行 3 cm 切口，暴露股骨近端外侧壁，放置定位导向器，沿定位导向器钻入导针股骨头软骨下 5 mm，沿导针安装 FNS，关闭切口。 [结果] 所有患者均顺利完成手术，手术时间平均（54.2±11.3）min，术中出血量平均（197.5±18.3）ml，透视时间平均（65.1± 3.2）s。随访时间平均（14.5±4.2）个月，骨折复位质量 Garden 指数Ⅰ级 16 例，Ⅱ级 5 例，所有患者骨折均愈合，骨折愈合时间（3.5±1.5）个月，末次随访髋关节 Harris 评分平均（84.5±4.2）分。[结论]C 形臂三维影像下牵引器复位(FNS 内固定治疗中青年股骨颈骨折提高复位精准度，骨折固定稳定，髋关节功能恢复满意。

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of femoral neck system (FNS) for internal fixation of femoral neck fracture under retractor traction and C-arm 3D image monitoring in middle-aged and young adults. [Methods] A total of 21 young and middle-aged patients underwent abovesaid surgical treatment for femoral neck fractures. The patient was placed in oblique lateral position with the affected side elevated 40° with beanbag. The pin in supracondylar of the fractured side was inserted, and a fracture retractor frame was installed. As longitudinally traction was applied with adduction and internal rotation, the fracture was reduced properly under C-arm 3D image monitoring, a longitudinal incision 3 cm in length was made at the greater trochanteric of the femur to ex- pose the proximal femur. As the guide was placed on the lateral aspect the femur, guide pins were inserted. Finally, the FNS was installed to fix the fracture following the guide pins with the screw tips 5mm below the femoral head cartilage surface under image monitoring, and then the incision was closed in layers. [Results] All patients were successfully operated on with operation time of (54.2±11.3) min, intraoperative blood loss of (197.5±18.3) ml, and fluoroscopy time of (65.1±3.2) seconds. All the patients were followed up for (14.5±4.2) months, got prop- er fracture reduction with Garden index grade I in 16 cases and grade II in 5 cases, got fracture healing in (3.5±1.5) months and were marked in Harris score at the last follow-up of (84.5±4.2). [Conclusion] The FNS used for internal fixation of femoral neck fracture under retractor traction and C-arm 3D image monitoring has advantages of improving the reduction, enhancing fixation stability and accuracy, and achieves satisfactory hip function recovery.