Helbig L, Werner M, Schneider S, Simank H G
Stiftung Orthopädische Universitätsklinik, Heidelberg.
Orthopade. 2005 Oct;34(10):1040-5. doi: 10.1007/s00132-005-0855-0.
Treatment recommendations vary for Garden I fractures of the proximal femur. The aim of our retrospective study was to determine the results of functional treatment of these injuries.
A total of 54 consecutive patients were enrolled, and their data (age, comorbidities, treatment, complications, etc.) were ascertained and stored in a database. Initial treatment consisted in early mobilization and weight bearing in all patients.
In 24 cases (44%) no complications at all were observed in the course of conservative treatment. In 28 cases (52%) surgical treatment was necessary due to early fracture dislocation. Analysis of the X-ray images showed that in 9 of these 28 cases the functional treatment had not been clearly indicated, i.e., incomplete impaction of the fragments. When these patients are excluded the success rate of conservative treatment was 53%, as two additional late complications occurred and were treated surgically (1x AVN, 1x nonunion). With reference to the survival rate, score, and patient satisfaction, there was no difference between conservative and operative treatment (p=0.478). The risk of a secondary dislocation increases with the number of risk factors (p=0.008).
An attempt at functional treatment with close X-ray monitoring is appropriate in these fractures, since this makes it possible to avoid surgery in about half of the patients while achieving functional results comparable to those yielded by surgery.
对于股骨近端Garden I型骨折，治疗建议各不相同。我们这项回顾性研究的目的是确定这些损伤采用功能治疗的结果。
总共纳入了54例连续患者，并确定了他们的数据（年龄、合并症、治疗方法、并发症等）并存储在数据库中。所有患者的初始治疗包括早期活动和负重。
在24例（44%）患者中，保守治疗过程中未观察到任何并发症。在28例（52%）患者中，由于早期骨折脱位需要进行手术治疗。对X线影像的分析显示，在这28例患者中有9例功能治疗并非明确必要，即骨折块嵌插不完整。如果排除这些患者，保守治疗的成功率为53%，因为又出现了2例晚期并发症并接受了手术治疗（1例股骨头缺血性坏死，1例骨不连）。在生存率、评分和患者满意度方面，保守治疗和手术治疗之间没有差异（p = 0.478）。二次脱位的风险随着危险因素数量的增加而增加（p = 0.008）。
对于这些骨折，尝试采用功能治疗并进行密切的X线监测是合适的，因为这有可能使大约一半的患者避免手术，同时获得与手术相当的功能结果。
