微创空心加压螺钉联合内侧支撑板治疗青壮年Garden,Ⅲ、Ⅳ型股骨颈骨折
[摘要] 目的 觀察应用直接前侧入路（DAA）切开复位空心加压螺钉联合内侧支撑板治疗青壮年Garden Ⅲ、Ⅳ型股骨颈骨折的临床效果。 方法 回顾性分析2014年11月～2015年9月在河南省洛阳正骨医院就诊并应用DAA入路切开复位空心加压螺钉联合内侧支撑板治疗并获得完整随访的37例青壮年股骨颈骨折患者的临床资料。随访观察骨折愈合及并发症情况，采用髋关节Harris评分评估患髋功能，采用Garden复位指数评价骨折复位情况。 结果 本研究37例患者均获得2年以上随访，术后3～6个月均获得骨性愈合，平均愈合时间为（4.40±0.96）个月，均未出现内固定松动及骨折再移位。1例患者于术后2年出现股骨头坏死，行保守治疗，髋关节活动未受明显影响；1例患者出现大腿外侧皮肤感觉减退，考虑为股外侧皮神经损伤所致，给予药物对症治疗，5个月后恢复。末次随访髋关节Harris评分为（89.66±4.52）分，术前评分为（40.41±6.98）分，差异有统计学意义（P < 0.05）。术后3 d和术后2年复查髋关节X线片测量的Garden复位指数比较，差异无统计学意义（P > 0.05）。 结论 运用DAA入路切开复位空心加压螺钉联合内侧支撑板治疗青壮年Garden Ⅲ、Ⅳ型股骨颈骨折，术中创伤小，复位准确，内固定牢靠，有利于患者术后早期活动康复，降低骨折不愈合及股骨头坏死的发生率，值得临床推广应用。
[关键词] 直接前侧入路；内侧支撑板；空心加压螺钉；青壮年；股骨颈骨折
[中图分类号] R683.42 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0067-05
Minimally invasive with cannulated compression screw combined with medial support plate in young adults with Garden Ⅲ and Ⅳ femoral neck fractures
WEN Yangyang1 LYV Jing1 SUN Haui1 FAN Ya′nan1 LI Wenlong2 JIA Yudong2 LIU Youwen2
1.Luoyang Working Department for Postgraduate Education， He′nan University of Chinese Medicine， He′nan Province， Zhengzhou 450046， China； 2.the Second Department of Hip Injury， He′nan Luoyang Orthopedic Traumatological Hospital Orthopaedic Hospital of He"nan Province， He"nan Province， Luoyang 471002， China
[Abstract] Objective To observe the clinical effect of open reduction with cannulated compression screw combined with medial support plate via direct anterior approach （DAA） in the treatment of Garden Ⅲ and Ⅳ femoral neck fractures in young adults. Methods Clinical data of 37 young patients with femoral neck fractures treated by cannulated compression screw combined with medial support plate via DAA approach in He′nan Luoyang Orthopedic Traumatological Hospita from November 2014 to September 2015 were eolled in this retrospective study. Fracture healing and complications were followed up and observed. The hip function was evaluated by hip Harris score and the fracture reduction was evaluated by Garden reset index. Results In this study， 37 patients were followed up for more than 2 years. All patients achieved bone healing in 3-6 months after operation， the average healing time was （4.40±0.96） months. No loosening of internal fixation or displacement of fracture occurred. Two years after operation， one patient had osteonecrosis of the femoral head， then the conservative treatment was performed， the activity of the hip joint was not significantly affected. One patient experienced a decrease in sensation of the skin outside the thigh， which was considered to be caused by injury of the lateral femoral cutaneous nerve and was given the drug symptomatic treatment， and recovered after 5 months. The final follow-up of the Harris hip score was （89.66±4.52）， which was significantly higher than the preoperative score （40.41 ± 6.98） （P < 0.05）. There was no significant difference in the Garden reset index between 3 d after operation and 2 years after the operation （P > 0.05）. Conclusion By using open reduction with hollow compression screw combined with medial support plate via DAA approach in the treatment of Garden Ⅲ and Ⅳ femoral neck fracture in young adults， the injury is small， the reduction is accurate and the internal fixation is firm， which is beneficial to early active rehabilitation after operation and to reduce the incidence of nonunion and necrosis of the femoral head. It is worth popularizing in clinic.