中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2013年
7期
708-713
,共6页
股骨颈骨折%内固定器%骨折固定术
股骨頸骨摺%內固定器%骨摺固定術
고골경골절%내고정기%골절고정술
Femoral neck fractures%Internal fixators%Fracture fixation
目的 探讨使用克氏针辅助闭合复位治疗难复性股骨颈骨折的可行性.方法 回顾性分析2008年6月至2011年4月治疗32例难复性股骨颈骨折患者资料,男15例,女17例；年龄21～59岁,平均46岁.根据Garden股骨颈骨折分型,Ⅱ型6例,Ⅲ型16例,Ⅳ型10例.根据患者术前X线及CT检查所示股骨头移位方向,将难复性股骨颈骨折分为:成角嵌插移位(11例)、旋转分离移位(15例)、外展嵌插移位(6例)三种类型.对于旋转分离和成角嵌插移位型骨折采用前方进针法,于股动脉外侧旁开1.5 cm处在X线透视下垂直向股骨头内锤入1～3枚直径3～3.5 mm的克氏针,进针深度约2～3 cm,克氏针向骨折移位的相反方向复位.外展嵌插移位型骨折采用侧方进针法,于大转子外侧向近端倾斜10°～15.锤入1～3枚3～3.5 mm直径的克氏针至股骨头内,向近端用力撬拨,使嵌插的骨折分离并复位,如仍不能复位,再于股骨干部垂直穿入1枚克氏针作为对抗针辅助骨折复位.复位满意后拧入空心钉固定.结果 32例难复性股骨颈骨折患者中,2例最终行切开复位内固定.30例经克氏针辅助闭合复位治疗患者骨折均达到或接近解剖复位.手术时间40～80 min,平均50 min；出血量20～50 ml,平均30 ml.术后Garden指数评价29例为解剖复位,1例为可接受复位.30例闭合复位患者中,29例获得随访,随访时间12～20个月,平均16个月.其中28例骨性愈合,愈合时间为4～10个月,平均时间为6个月；1例术前为旋转分离移位患者于术后15个月发生股骨头坏死,行人工全髋关节置换术治疗.结论 使用克氏针辅助闭合复位治疗难复性股骨颈骨折可获得满意的解剖复位率和骨折愈合率.
目的 探討使用剋氏針輔助閉閤複位治療難複性股骨頸骨摺的可行性.方法 迴顧性分析2008年6月至2011年4月治療32例難複性股骨頸骨摺患者資料,男15例,女17例；年齡21～59歲,平均46歲.根據Garden股骨頸骨摺分型,Ⅱ型6例,Ⅲ型16例,Ⅳ型10例.根據患者術前X線及CT檢查所示股骨頭移位方嚮,將難複性股骨頸骨摺分為:成角嵌插移位(11例)、鏇轉分離移位(15例)、外展嵌插移位(6例)三種類型.對于鏇轉分離和成角嵌插移位型骨摺採用前方進針法,于股動脈外側徬開1.5 cm處在X線透視下垂直嚮股骨頭內錘入1～3枚直徑3～3.5 mm的剋氏針,進針深度約2～3 cm,剋氏針嚮骨摺移位的相反方嚮複位.外展嵌插移位型骨摺採用側方進針法,于大轉子外側嚮近耑傾斜10°～15.錘入1～3枚3～3.5 mm直徑的剋氏針至股骨頭內,嚮近耑用力撬撥,使嵌插的骨摺分離併複位,如仍不能複位,再于股骨榦部垂直穿入1枚剋氏針作為對抗針輔助骨摺複位.複位滿意後擰入空心釘固定.結果 32例難複性股骨頸骨摺患者中,2例最終行切開複位內固定.30例經剋氏針輔助閉閤複位治療患者骨摺均達到或接近解剖複位.手術時間40～80 min,平均50 min；齣血量20～50 ml,平均30 ml.術後Garden指數評價29例為解剖複位,1例為可接受複位.30例閉閤複位患者中,29例穫得隨訪,隨訪時間12～20箇月,平均16箇月.其中28例骨性愈閤,愈閤時間為4～10箇月,平均時間為6箇月；1例術前為鏇轉分離移位患者于術後15箇月髮生股骨頭壞死,行人工全髖關節置換術治療.結論 使用剋氏針輔助閉閤複位治療難複性股骨頸骨摺可穫得滿意的解剖複位率和骨摺愈閤率.
목적 탐토사용극씨침보조폐합복위치료난복성고골경골절적가행성.방법 회고성분석2008년6월지2011년4월치료32례난복성고골경골절환자자료,남15례,녀17례；년령21～59세,평균46세.근거Garden고골경골절분형,Ⅱ형6례,Ⅲ형16례,Ⅳ형10례.근거환자술전X선급CT검사소시고골두이위방향,장난복성고골경골절분위:성각감삽이위(11례)、선전분리이위(15례)、외전감삽이위(6례)삼충류형.대우선전분리화성각감삽이위형골절채용전방진침법,우고동맥외측방개1.5 cm처재X선투시하수직향고골두내추입1～3매직경3～3.5 mm적극씨침,진침심도약2～3 cm,극씨침향골절이위적상반방향복위.외전감삽이위형골절채용측방진침법,우대전자외측향근단경사10°～15.추입1～3매3～3.5 mm직경적극씨침지고골두내,향근단용력효발,사감삽적골절분리병복위,여잉불능복위,재우고골간부수직천입1매극씨침작위대항침보조골절복위.복위만의후녕입공심정고정.결과 32례난복성고골경골절환자중,2례최종행절개복위내고정.30례경극씨침보조폐합복위치료환자골절균체도혹접근해부복위.수술시간40～80 min,평균50 min；출혈량20～50 ml,평균30 ml.술후Garden지수평개29례위해부복위,1례위가접수복위.30례폐합복위환자중,29례획득수방,수방시간12～20개월,평균16개월.기중28례골성유합,유합시간위4～10개월,평균시간위6개월；1례술전위선전분리이위환자우술후15개월발생고골두배사,행인공전관관절치환술치료.결론 사용극씨침보조폐합복위치료난복성고골경골절가획득만의적해부복위솔화골절유합솔.
Objective To investigate the feasibility of closed reduction assisted with Kirschner wires for irreducible femoral neck fracture.Methods From June 2008 to April 2011,32 patients with irreducible femoral neck fracture were treated.There were 15 males and 17 females,aged from 21 to 59 years (average,46 years).According to Garden classification,there were 6 of Ⅱ,16 of Ⅲ and 10 of Ⅳ.According to displacement direction of the femoral head showed by preoperative X-rays and CT scans,irreducible femoral neck fracture was divided into 3 types:angulation-impaction (11 cases),rotation-separation (15 cases) and abduction-impaction (6 cases).One to three Kirschner wires were penetrated into the femoral head to reduce the displacement in opposite direction of fracture displacement.After reduction was satisfied,guide pins were penetrated,and then the fractures were fixed with cannulated screws.Results Anatomic or nearly anatomic reduction was achieved in 30 patients after closed reduction assisted with Kirschner wires.Two patients underwent open reduction finally due to failure of closed reduction.The operation time ranged from 40 to 80 min,and the blood loss ranged from 20 to 50 ml.According to Garden index,anatomic reduction was achieved in 29 and acceptable reduction in 1.Among 30 patients who had undergone closed reduction,29 patients were followed up for 12 to 20 months.Bone union was achieved in 28 patients,and the fracture healing time ranged from 4 to 10 months.One patient with rotation-separation displacement before closed reduction underwent total hip replacement due to avascular necrosis of femoral head occurred at 15 months after closed reduction.Conclusion Closed reduction assisted with Kirschner wires is an effective method for irreducible femoral neck fracture,which can achieve satisfactory anatomic reduction rate and fracture healing rate.
