采用动力髋螺钉治疗年轻患者移位型股骨颈骨折及其与骨坏死的关联。
Treatment of displaced femoral neck fractures in young patients with DHS and its association to osteonecrosis.
作者信息
Schwartsmann Carlos Roberto, Lammerhirt Henrique Marquardt, Spinelli Leandro de Freitas, Ungaretti Neto Ary da Silva
机构信息
Departamento de Ortopedia e Traumatologia, Universidade Federal de Ciências da Saúde, Porto Alegre, RS, Brazil.
Departamento de Ortopedia e Traumatologia, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
出版信息
Rev Bras Ortop. 2017 Mar 12;53(1):82-87. doi: 10.1016/j.rboe.2017.03.003. eCollection 2018 Jan-Feb.
OBJECTIVE
The purpose of this study is to evaluate the performance of dynamic hip screw for the treatment of dislocated femoral neck fractures in young patients, focusing on osteonecrosis.
METHODS
A series of 53 patients with less than 55 years of age were retrospectively evaluated. All patients had dislocated femoral neck fractures (Garden III or IV) and were treated with DHS. Ficat's staging system was used to evaluate avascular necrosis.
RESULTS
There were 38 (71.7%) males and 15 (28.3%) females, with an overall mean age at the onset of fracture of 41.9 years (±12.8). According to Garden's classification, 21 (39.6%) fractures were classified as type III and 32 (60.4%) were considered totally dislocated, Garden IV. Fracture healing was achieved in 39 patients (73.6%). Thirteen cases of avascular necrosis were observed (24.6%).
CONCLUSIONS
The incidence of avascular necrosis in young patients with a displaced femoral neck fractures treated with DHS was 24.6%. No statistically significant association was found between times elapsed to surgery, fracture displacement, and presence of derotation screw with osteonecrosis. Level of evidence IV.
目的
本研究旨在评估动力髋螺钉治疗年轻患者股骨颈骨折脱位的疗效，重点关注骨坏死情况。
方法
对53例年龄小于55岁的患者进行回顾性评估。所有患者均为股骨颈骨折脱位（GardenⅢ型或Ⅳ型），并接受动力髋螺钉治疗。采用Ficat分期系统评估缺血性坏死情况。
结果
男性38例（71.7%），女性15例（28.3%），骨折发生时的总体平均年龄为41.9岁（±12.8）。根据Garden分类，21例（39.6%）骨折为Ⅲ型，32例（60.4%）为完全脱位的GardenⅣ型。39例（73.6%）患者骨折愈合。观察到13例缺血性坏死（24.6%）。
结论
采用动力髋螺钉治疗的年轻移位型股骨颈骨折患者，缺血性坏死的发生率为24.6%。手术时间、骨折移位和旋转螺钉的存在与骨坏死之间未发现统计学上的显著关联。证据等级为Ⅳ级。
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