股骨内侧钢板联合空心钉内固定治疗中青年不稳定型股骨颈骨折效果观察

发布时间：2019-03-13 18:25

【摘要】：目的观察股骨内侧钢板联合空心钉内固定治疗中青年不稳定型股骨颈骨折的临床疗效。方法将22例中青年不稳定型股骨颈骨折患者随机分为观察组和对照组各11例,对照组采用空心钉内固定治疗,观察组采用股骨内侧钢板联合空心钉内固定治疗。采用髋关节Harris评分评估术前及术后第3、6、12个月髋关节功能,参照骨折临床愈合标准判断骨折愈合情况,采用VAS评价术前及术后第3、6、12个月疼痛情况,统计术后股骨头坏死情况。结果两组内固定物长度适中,位置满意,未累及关节面或进入关节腔;均无重要血管损伤,未发现髋关节活动限制;切口均达甲级愈合,未发现切口感染。观察组9例骨性愈合并负重行走,1例骨折线明显模糊;均未见股骨头坏死征象,髋关节活动良好无限制。对照组6例骨性愈合并负重行走,4例骨折线明显模糊;1例术后第7个月出现股骨头坏死,空心钉切出并退钉,后行全髋关节置换术。两组术后各时点与术前比较,Harris评分均升高、VAS均降低(P均0.01);与对照组比较,观察组术后各时点Harris评分均升高(P均0.05),术后第6、12个月VAS均降低(P均0.05)。结论采用股骨内侧钢板联合空心钉内固定治疗中青年不稳定型股骨颈骨折,可有效复位骨折并稳定内固定,改善髋关节功能并减轻疼痛。
[Abstract]:Objective to observe the clinical effect of medial femoral plate combined with hollow nail fixation in the treatment of unstable femoral neck fracture in middle and young people. Methods 22 young and middle-aged patients with unstable femoral neck fracture were randomly divided into observation group (n = 11) and control group (n = 11). The control group was treated with hollow nail internal fixation, and the observation group was treated with medial femoral plate combined with hollow nail internal fixation. Hip joint function was evaluated by Harris before operation and 3,6,12 months after operation. Fracture healing was evaluated according to clinical criteria of fracture healing. Pain was evaluated by VAS before operation and 3,6,12 months after operation. The necrosis of femoral head after operation was counted. Results the length of internal fixator in both groups was moderate, the position was satisfactory, the articular surface was not involved or entered into the joint cavity, there was no important vascular injury, no restriction of hip joint activity was found, the incision healed in grade A and no incision infection was found. In the observation group, there were 9 cases of bone healing and weight-bearing walking, 1 case of fracture line obviously blurred, no sign of osteonecrosis of femoral head and good activity of hip joint. In the control group, bone healing and weight-bearing walking were found in 6 cases, fracture line was obviously blurred in 4 cases, osteonecrosis of femoral head appeared in 1 case 7 months after operation, hollow nail was cut out and removed, then total hip arthroplasty was performed. Compared with pre-operation, Harris scores increased and VAS decreased in both groups at each time point after operation (P0.01). Compared with the control group, the Harris scores in the observation group increased at all time points after operation (all P0.05), and the VAS decreased at the 6th and 12th months after the operation (all P0.05). Conclusion the treatment of unstable femoral neck fracture with medial femoral plate combined with hollow nail fixation can effectively reduce fracture and stabilize internal fixation, improve hip joint function and relieve pain.
【作者单位】：山东中医药大学;山东中医药大学附属医院;
【分类号】：R687.3

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