空心钉联合旋髂深动脉骨移植治疗青壮年股骨颈骨折的疗效

Effect of cannulated screws with deep circumflex iliac artery-bone grafting in the treatment of femoral neck fracture in young adults.

作者信息

Li Guanghui, Jin Dadi, Shao Xianfang, Liu Zhijun, Duan Jianhui, Akileh Raji, Cao Shousong, Liu Tuoen

机构信息

Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, 510630, China; Department of Orthopedic Surgery, The First Traditional Chinese Medical Hospital of Hunan Changde, Changde, Hunan, 415000, China.

Department of Orthopedic Surgery, The Third Affiliated Hospital, Southern Medical University, Guangzhou, Guangdong, 510630, China.

出版信息

Injury. 2018 Aug;49(8):1587-1593. doi: 10.1016/j.injury.2018.06.014. Epub 2018 Jun 12.

DOI:10.1016/j.injury.2018.06.014

PMID:29929779

Abstract

OBJECTIVES

Surgical treatment of femoral neck fracture in young adults is clinically challenging due to the high incidence of avascular necrosis of femoral head and fracture nonunion. The objective of this study is to evaluate the effectiveness of cannulated screws with deep circumflex iliac artery bone grafting (DCIABG) by comparing to the routinely used method in the treatment of femoral neck fracture in young adults.

METHODS

From March 2006 to December 2012, a total of 185 patients with femoral neck fracture were admitted to the hospital for internal fixation surgery, 103 patients (61 males and 42 females, mean age of 39.1 years) were treated with three cannulated screws with DCIABG (group A), and 82 patients (49 males and 33 females, mean age of 35.5 years) were treated with three cannulated screws without DCIABG (group B).

RESULTS

All patients were followed up for at least 24 months after the surgery. The patients in group A had a significantly higher Harris Hip Score (p < 0.001), shorter fracture healing time (p < 0.001), lower occurrence rate of avascular necrosis of femoral head (p = 0.008) and fracture nonunion (p = 0.012) compared to the patients in group B. However, the operation time and intraoperative blood loss were significantly lower in patients in group B than those in group A (p < 0.001).

CONCLUSIONS

Cannulated screws with DCIABG significantly reduced femoral head osteonecrosis and fracture nonunion. Therefore, it is a feasible and effective method in the treatment of young adult patients with femoral neck fracture.

摘要

目的

由于股骨头缺血性坏死和骨折不愈合的发生率较高，年轻成人股骨颈骨折的手术治疗在临床上具有挑战性。本研究的目的是通过与治疗年轻成人股骨颈骨折的常规方法进行比较，评估空心螺钉联合旋髂深动脉骨移植（DCIABG）的有效性。

方法

2006年3月至2012年12月，共有185例股骨颈骨折患者入院接受内固定手术，103例患者（男61例，女42例，平均年龄39.1岁）采用三根空心螺钉联合DCIABG治疗（A组），82例患者（男49例，女33例，平均年龄35.5岁）采用三根空心螺钉但不联合DCIABG治疗（B组）。

结果

所有患者术后至少随访24个月。与B组患者相比，A组患者的Harris髋关节评分显著更高（p<0.001），骨折愈合时间更短（p<0.001），股骨头缺血性坏死发生率更低（p=0.008），骨折不愈合发生率更低（p=0.012）。然而，B组患者的手术时间和术中出血量显著低于A组患者（p<0.001）。