CAJ | 학술논문

目的：探讨应用股骨头干三维互动闭合复位动力髋螺钉（dynamic hip screw，DHS）加防旋螺钉内固定治疗PauwelsⅢ型股骨颈骨折的临床疗效。方法应用DHS联合防旋螺钉内固定治疗PauwelsⅢ型股骨颈骨折19例。骨折解剖位置分型：头下型14例，头颈型5例；按Garden分型：Ⅲ型7例，Ⅳ型12例，其中伴有股骨头旋转2例。所有骨折均采用股骨头干三维互动闭合复位技术复位，复位满意后应用DHS联合1枚防旋螺钉内固定。结果利用Garden对线指数对股骨颈骨折复位进行评价，Ⅰ级复位16例（84.2％），Ⅱ级复位3例（15.8％）。手术时间50～65min，平均（52.2±2.4） min，出血量40～80ml，平均（48.7±3.2）ml。所有患者术后均获随访，随访时间13～25个月（平均18.5个月），骨折全部愈合，无一例发生股骨头缺血性坏死及髋内翻等并发症。 Harris髋关节评分为89～100分。结论股骨头干三维互动闭合复位DHS加防旋螺钉内固定治疗PauwelsⅢ型股骨颈骨折，并发症少，成功率高。
목적：탐토응용고골두간삼유호동폐합복위동력관라정（dynamic hip screw，DHS）가방선라정내고정치료PauwelsⅢ형고골경골절적림상료효。방법응용DHS연합방선라정내고정치료PauwelsⅢ형고골경골절19례。골절해부위치분형：두하형14례，두경형5례；안Garden분형：Ⅲ형7례，Ⅳ형12례，기중반유고골두선전2례。소유골절균채용고골두간삼유호동폐합복위기술복위，복위만의후응용DHS연합1매방선라정내고정。결과이용Garden대선지수대고골경골절복위진행평개，Ⅰ급복위16례（84.2％），Ⅱ급복위3례（15.8％）。수술시간50～65min，평균（52.2±2.4） min，출혈량40～80ml，평균（48.7±3.2）ml。소유환자술후균획수방，수방시간13～25개월（평균18.5개월），골절전부유합，무일례발생고골두결혈성배사급관내번등병발증。 Harris관관절평분위89～100분。결론고골두간삼유호동폐합복위DHS가방선라정내고정치료PauwelsⅢ형고골경골절，병발증소，성공솔고。
Objective To evaluate the therapeutic efficacy of closed reduction technique with dynamic hip screw and anti-rotation screw in treating patients with Pauwels type Ⅲfemoral neck fracture.Methods From Jan. 2010 to Nov.2011,19 cases of Pauwels type III femoral neck fractures were admitted into our centre .According to the Delbet classification,there were 14 cases of subcapital fractures and 5 cases of transcervical fractures .Mean-while,referring to the Garden classification,there were 7 cases of type Ⅲand 12 cases of type Ⅳ.Two cases were associated with femoral head rotation .All cases were treated by closed reduction technique ,and then fixed with dy-namic hip screw and anti -rotation screw.Results In terms of the curative efficacy,16 of all patients (84.2%) achieved an anatomical reduction ,while 3 cases achieved an acceptable reduction (15.8%).The operation time ranged from 50 minutes to 65 minutes (averaging 52.2 ±2.4 minutes).The blood loss during surgery ranged from 40 to 80 ml(averaging 48.7 ±3.2) ml.The patients were followed up for 13-25 months with an average of 18.5 months.All fractures healed without complications such as femoral head avascular necrosis .The Harris hip joint score ranged from 89 to 100.Conclusion The closed reduction technique with dynamic hip screw and anti-rotation screw for treating Pauwels type Ⅲfemoral neck fracture has the advantages of less complications and high success rate.