CAJ | 학술논문

目的比较切开复位与闭合复位内固定治疗移位型股骨颈骨折(Garden Ⅲ、Ⅳ型)的疗效.方法回顾件分析1998年1月至2006年6月收治且状得完整随访的122例成人移位型股骨颈骨折患者资料,根据复位方式不同分为两组:闭合复位组73例,男42例,女31例;平均年龄(56.2±2.4)岁;骨折Garden分型:Ⅲ型43例,Ⅳ型30例.切开复位组49例,男30例,女19例;平均年龄(57.5±3.1)岁;骨折Garden分型:Ⅲ型27例,Ⅳ型22例.对比分析两组患者的骨折复位质量、内固定置人满意率、骨折不愈合发生率及股骨头缺血性坏死率.结果 122例患者术后获20～101个月(平均50.3个月)随访.闭合复位组骨折复位质量:Ⅰ级39例,Ⅱ级19例,Ⅲ级或Ⅳ级15例;开放复位组Ⅰ级38例,Ⅱ级9例,Ⅲ级或Ⅳ级2例,两组比较差异有统计学意义(x2=9.519,P=0.010).两组患者术后内同定置人满意率分别为86.3%(63/73)、87.8%(43/49),骨折不愈合发牛率分别为8.2%(6/73)、6.1%(3/49),两组比较筹异均无统计学意义(P>0.05).切开复位组股骨头缺血性坏死率(10.2%)低于闭合复位组(27.4%),差异有统计学意义(x2=5.320,P=0.021).结论对于移位型股骨颈骨折,切开复位内固定并不会增加术后股骨头缺血性坏死的发生率.对闭合复位失效或骨折移位明显的患者,及时行切开复位内固定是非常有必要的.
목적 비교절개복위여폐합복위내고정치료이위형고골경골절(Garden Ⅲ、Ⅳ형)적료효.방법 회고건분석1998년1월지2006년6월수치차상득완정수방적122례성인이위형고골경골절환자자료,근거복위방식불동분위량조:폐합복위조73례,남42례,녀31례;평균년령(56.2±2.4)세;골절Garden분형:Ⅲ형43례,Ⅳ형30례.절개복위조49례,남30례,녀19례;평균년령(57.5±3.1)세;골절Garden분형:Ⅲ형27례,Ⅳ형22례.대비분석량조환자적골절복위질량、내고정치인만의솔、골절불유합발생솔급고골두결혈성배사솔.결과 122례환자술후획20～101개월(평균50.3개월)수방.폐합복위조골절복위질량:Ⅰ급39례,Ⅱ급19례,Ⅲ급혹Ⅳ급15례;개방복위조Ⅰ급38례,Ⅱ급9례,Ⅲ급혹Ⅳ급2례,량조비교차이유통계학의의(x2=9.519,P=0.010).량조환자술후내동정치인만의솔분별위86.3%(63/73)、87.8%(43/49),골절불유합발우솔분별위8.2%(6/73)、6.1%(3/49),량조비교주이균무통계학의의(P>0.05).절개복위조고골두결혈성배사솔(10.2%)저우폐합복위조(27.4%),차이유통계학의의(x2=5.320,P=0.021).결론 대우이위형고골경골절,절개복위내고정병불회증가술후고골두결혈성배사적발생솔.대폐합복위실효혹골절이위명현적환자,급시행절개복위내고정시비상유필요적.
Objective To compare the clinical effects of open reduction and closed reduction in treatment of the displaced femoral neck fractures(Garden types Ⅲ and Ⅳ). Methods The clinic data of 122 patients who had been treated for displaced femoral neck fractures in our hospital from January 1998 to June 2006 were included for the present respective analysis.Of them,73 cases were treated with closed reduetion and 49 with open reduction.In the closed reduction group,there were 42 men and 31 women(mean age,56.2±2.4 years),and 43 cases of Garden Ⅲ and 30 eases of Garden Ⅳ.In the open reduction group,there were 30 men and 19 women(mean age,57.5±3.1 years),and 27 cases of Garden Ⅲ and 22 cases of Garden Ⅳ.The 2 groups were compared in reduction quality.satisfactory fixation,ratio of nonunion and ratio of femoral avascular necrosis. Results The 122 patients received a mean follow-up of 50.3 months (from 20 to 101 months).The reduction quality was rated as grade Ⅰ in 39 cases,as gradeⅡin 19 cases,as grade Ⅲ or Ⅳ in 15 cases in the closed group,and as grade Ⅰ in 38 cases,as grade Ⅱ in 9 cases,as grade Ⅲ or Ⅳ in 2 eases in the open group.The differences between the 2 groups were significant(x2=9.519,P=0.010).There were no significant differences between the 2 groups in satisfactory fixation(86.3%venus 87.8%)or in nonunion ratio(8.2%versus 6.1%)(P>0.05).The ratio of femoral avascular necrosis for the open reduction group(10.2%)was significantly lower than that for the closed reduction group (27.4%)(x2=5.320,P=0.021). Conclusion Since open reduction can lower the ratio of femoral avascular necrosis for displaced femoral neck fractures,it is essential to perform timely open reduction when closed reduction fails or the fracture is obviously displaced.